Dataset Information

Diabetes associates with mortality in critically ill patients with SARS-CoV-2 pneumonia: No diabetes paradox in COVID-19.

ABSTRACT:

Background

Diabetes mellitus (DM) is not associated with increased mortality in critically ill patients, a phenomenon known as the "diabetes paradox". However, DM is a risk factor for increased mortality in patients with COVID-19. This study aims to investigate the association of DM and stress-induced hyperglycemia at intensive care unit (ICU) with mortality in this population.

Methods

This is a retrospective study. Electronic medical records from patients admitted from March 2020 to September 2020 were reviewed. Primary outcome was mortality. Secondary outcomes were ICU and hospital mortality and stay, and need for mechanical ventilation and renal replacement therapy.

Results

187 patients were included. Overall mortality was 43.2%, higher in patients with DM (55.7% vs. 34%; p = 0.007), even after adjustment for age, hypertension, and disease severity. When patients were separated into groups, named normoglycemia (without DM and glycemia ≤140 mg/dL), stress-induced hyperglycemia (without DM and glycemia >140 mg/dL), and DM (previous diagnosis or HbA1c ≥ 6.5%), the mortality rate was 25.8%, 37.3%, and 55.7%, respectively (p = 0.021). Mortality was higher in patients with higher glycemic variability. No statistical difference related to secondary outcomes was observed.

Conclusions

DM, hyperglycemia, and glycemic variability associated with increased mortality in critically ill patients with severe COVID-19, but did not increase the rates of other clinical outcomes. More than stress-induced hyperglycemia, DM was associated with mortality.

SUBMITTER: Bellaver P

PROVIDER: S-EPMC10412986 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Publications

Diabetes associates with mortality in critically ill patients with SARS-CoV-2 pneumonia: No diabetes paradox in COVID-19.

Bellaver Priscila P Schneider Larissa L Schaeffer Ariell F AF Henrique Lilian Rodrigues LR Camargo Joíza Lins JL Gerchman Fernando F Leitão Cristiane B CB Rech Tatiana H TH

Heliyon 20230722 8

<h4>Background</h4>Diabetes mellitus (DM) is not associated with increased mortality in critically ill patients, a phenomenon known as the "diabetes paradox". However, DM is a risk factor for increased mortality in patients with COVID-19. This study aims to investigate the association of DM and stress-induced hyperglycemia at intensive care unit (ICU) with mortality in this population.<h4>Methods</h4>This is a retrospective study. Electronic medical records from patients admitted from March 2020 ...[more]

PMID: 37576227

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Project description:BackgroundHeart rate variability (HRV) has prognostic value for predicting mortality in both cardiovascular and sepsis patients. Decreased HRV has been associated with increased mortality and morbidity. However, the prognostic significance of HRV in critically ill patients COVID-19 pneumonia still remains unknown. The current study aimed to (1) evaluate prognostic utility of HRV parameters on outcomes in patients with severe COVID-19 pneumonia and (2) assess the correlation between HRV parameters and inflammatory markers.MethodsConsecutive critically ill patients with COVID-19 pneumonia admitted to a tertiary referral intensive care unit from October 2021 to June 2022 in Bangkok, Thailand were enrolled. HRV parameters over the 24 h following intensive care unit admission were recorded using telemetry and analyzed using the Holter program (Philips Holter 2010 Plus/1810 Series). Receiver-operating characteristic (ROC) curve analysis was used to determine optimum threshold cutoffs of various HRV parameters. Formal comparisons of in-hospital mortality between patients with and without a decrease in HRV were performed using Cox regression after adjusting for potential confounders.ResultsA total of 65 patients were enrolled in the study. Patients were classified into two groups: survivors (n = 44, 68 %) and non-survivors (n = 21, 32 %). The standard deviation of normal-to-normal intervals (SDNN) was significantly lower in non-survivors than in survivors (70.30 vs. 105.95; p = 0.03). The SDNN predicted in-hospital mortality with an area under the ROC curve of 0.67 (95 % CI 0.55-0.79). At a cutoff of 70 ms, the SDNN showed a sensitivity and specificity of 0.48 and 0.86. The low SDNN group (<70 ms) demonstrated higher median ferritin, IL-6, and hs-C-reactive protein levels than did the normal SDNN group, although such differences did not reach statistical significance (1139.0 vs. 508.4; p = 0.137 and 91.2 vs. 64.4; p = 0.352, respectively). After adjusting for potential confounders in the multivariable model, the adjusted hazard ratio for in-hospital mortality in those with SDNN <70 ms was 3.70 (95 % CI 1.34-10.24).ConclusionA decrease in SDNN, a commonly used HRV parameter, was associated with mortality and inflammatory biomarkers in critically ill patients with COVID-19 pneumonia.

Project description:Micronutrient deficiencies can develop in critically ill patients, arising from factors such as decreased intake, increased losses, drug interactions, and hypermetabolism. These deficiencies may compromise important immune functions, with potential implications for patient outcomes. Alternatively, micronutrient blood levels may become low due to inflammation-driven redistribution rather than consumption. This explorative pilot study investigates blood micronutrient concentrations during the first three weeks of ICU stay in critically ill COVID-19 patients and evaluates the impact of additional micronutrient administration. Moreover, associations between inflammation, disease severity, and micronutrient status were explored. We measured weekly concentrations of vitamins A, B6, D, and E; iron; zinc; copper; selenium; and CRP as a marker of inflammation state and the SOFA score indicating disease severity in 20 critically ill COVID-19 patients during three weeks of ICU stay. Half of the patients received additional (intravenous) micronutrient administration. Data were analyzed with linear mixed models and Pearson's correlation coefficient. High deficiency rates of vitamins A, B6, and D; zinc; and selenium (50-100%) were found at ICU admission, along with low iron status. After three weeks, vitamins B6 and D deficiencies persisted, and iron status remained low. Plasma levels of vitamins A and E, zinc, and selenium improved. No significant differences in micronutrient levels were found between patient groups. Negative correlations were identified between the CRP level and levels of vitamins A and E, iron, transferrin, zinc, and selenium. SOFA scores negatively correlated with vitamin D and selenium levels. Our findings reveal high micronutrient deficiency rates at ICU admission. Additional micronutrient administration did not enhance levels or expedite their increase. Spontaneous increases in vitamins A and E, zinc, and selenium levels were associated with inflammation resolution, suggesting that observed low levels may be attributed, at least in part, to redistribution rather than true deficiencies.

Dataset Information

Diabetes associates with mortality in critically ill patients with SARS-CoV-2 pneumonia: No diabetes paradox in COVID-19.

Background

Methods

Results

Conclusions

Publications

Diabetes associates with mortality in critically ill patients with SARS-CoV-2 pneumonia: No diabetes paradox in COVID-19.

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