Fri Feb 04 2022

Inflammation, hyperglycemia, and adverse outcomes in individuals with diabetes mellitus hospitalized for COVID-19

Objective

Diabetes mellitus (DM) is a major risk factor for severe coronavirus disease 2019 (COVID-19) for reasons that are unclear.

Article about inflammation, hyperglycemia , and adverse outcomes in individuals with diabetes

Research and design methods

The International Study of Inflammation in COVID-19 (ISIC) is a multicenter observational study that analyzed 2,044 hospitalized COVID-19 patients to examine the effect of diabetes mellitus (DM) on in-hospital outcomes. It also evaluated how inflammation and hyperglycemia contribute to DM-related risks. Researchers measured inflammation biomarkers at admission and monitored glucose levels and insulin data during the hospital stay. The primary outcome focused on in-hospital death, mechanical ventilation requirement, and renal replacement therapy need.

Results

In a study of participants with an average age of 60 years, 58.2% of whom were males, those with diabetes mellitus (DM) (33.5% of 686 participants) experienced a significantly higher occurrence of the primary outcome (37.8% vs. 28.6%) compared to those without DM. They also showed higher levels of inflammatory biomarkers. Specifically, diabetes was linked to increased levels of soluble urokinase plasminogen activator receptor (suPAR) in a detailed analysis. However, when adjusting for suPAR levels, the link between diabetes and the primary outcome weakened (adjusted odds ratio 1.23 [95% CI 0.78, 1.37]). Mediation analysis revealed that suPAR accounted for 84.2% of diabetes’ effect on the primary outcome. Regardless of suPAR levels, high blood sugar and greater insulin doses remained independent predictors of the primary outcome.

Conclusions

Our findings suggest that the association between DM and outcomes in COVID-19 is largely mediated by hyperinflammation as assessed by suPAR levels, while the impact of hyperglycemia is independent of inflammation.

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