Stress Hyperglycemia in Patients Hospitalized for COVID-19

Stress hyperglycemia is common in hospitalized patients and often is associated with poor outcomes. In patients with coronavirus disease 2019 (COVID-19), the incidence of stress hyperglycemia remains unknown. In this dissertation, I aimed to estimate the incidence of stress hyperglycemia in non-diabetic patients hospitalized for COVID-19 and to characterize the association of stress hyperglycemia with mortality. I did this in two major studies:

I first conducted a systematic review and meta-analysis to assess the epidemiology of COVID-19 and stress hyperglycemia. PubMed, SCOPUS, OVID, and Cochrane Library databases and preprint repositories were searched from January 1, 2020, to April 1, 2021. Random-effects models were used to estimate the pooled incidence of stress hyperglycemia and its association with mortality. Sub-group analysis was conducted to explore reasons for heterogeneity. Eight cohort studies were identified that included 3,075 patients from three continents. The median age and mean body mass index were 59 years and 28 kg/m2, respectively, and 60% were male. The pooled incidence of stress hyperglycemia was 34%(95% confidence interval (CI): 23%-48%) in non-diabetic patients. Stress hyperglycemia was associated with a 2-fold higher risk of ventilation (risk ratio (RR)= 2.01, 95% CI=1.30-3.09) and mortality (RR= 2.11, 95%CI= 1.24-3.59).

Secondly, I conducted a retrospective cohort study on adult patients in which I evaluated the causal link of stress hyperglycemia and acute kidney injury (AKI) in COVID-19 mortality. The records of 1,372 adult patients admitted to Penn State Milton S. Hershey Medical Center for a diagnosis of COVID-19 who had at least one glucose measurement within 48 hours of admission were reviewed. Diabetes was an effect modifier in the association between hyperglycemia and COVID-19 (p=0.028). Stress hyperglycemia was a predictor of acute kidney injury, ICU admission, and mortality in non-diabetic patients but not those with a history of diabetes. While controlling for age, sex, and chronic kidney disease, patients with stress hyperglycemia who did not have a history of diabetes were at a 2-fold greater risk of AKI (OR:1.65, 95%CI: 1.10, 2.49), ICU admission (OR:2.32, 95%CI 1.58, 3.39) and mortality (OR: 2.22, 95%CI 1.25, 3.96). Acute kidney injury mediated the relationship between hyperglycemia and COVID-19 mortality by 52%.

In conclusion, stress hyperglycemia is common in non-diabetic adult patients hospitalized for COVID-19 and is a risk factor for poor prognosis and mortality. Routine screening of stress hyperglycemia should inform risk stratification and guide precise treatment strategies to optimize survival.

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Work Title Stress Hyperglycemia in Patients Hospitalized for COVID-19
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  1. Anna Ssentongo
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Work Type Dissertation
Publication Date May 2021
Deposited August 10, 2021

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    August 10, 2021 14:25 by aer5210

  • Added Creator Anna Ssentongo

    August 10, 2021 14:25 by aer5210

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  • Updated Work Title Show Changes

    May 21, 2024 13:38 by avs5190

    Work Title
    • STRESS HYPERGLYCEMIA IN PATIENTS HOSPITALIZED FORCOVID-19
    • Stress Hyperglycemia in Patients Hospitalized for COVID-19
  • Updated Description Show Changes

    May 21, 2024 13:39 by avs5190

    Description
    • Stress hyperglycemia is common in hospitalized patients and often is associated with poor outcomes. In patients with coronavirus disease 2019 (COVID-19), the incidence of stress hyperglycemia remains unknown. In this dissertation, I aimed to estimate the incidence of stress hyperglycemia in non-diabetic patients hospitalized for COVID-19and to characterize the association of stress hyperglycemia with mortality. I did this in two major studies: I first conducted a systematic review and meta-analysis to assess the epidemiology ofCOVID-19 and stress hyperglycemia. PubMed, SCOPUS, OVID, and Cochrane Library databases and preprint repositories were searched from January 1, 2020, to April 1, 2021.Random-effects models were used to estimate the pooled incidence of stress hyperglycemia and its association with mortality. Sub-group analysis was conducted to explore reasons for heterogeneity. Eight cohort studies were identified that included 3,075 patients from three continents. The median age and mean body mass index were 59 years and 28 kg/m2,respectively, and 60% were male. The pooled incidence of stress hyperglycemia was 34%(95% confidence interval (CI): 23%-48%) in non-diabetic patients. Stress hyperglycemia was associated with a 2-fold higher risk of ventilation (risk ratio (RR)= 2.01, 95% CI=1.30-3.09) and mortality (RR= 2.11, 95%CI= 1.24-3.59).Secondly, I conducted a retrospective cohort study on adult patients in which I evaluated the causal link of stress hyperglycemia and acute kidney injury (AKI) in COVID-19mortality. The records of 1,372 adult patients admitted to Penn State Milton S. Hershey Medical Center for a diagnosis of COVID-19 who had at least one glucose measurement within 48 hours of admission were reviewed. Diabetes was an effect modifier in the association between hyperglycemia and COVID-19 (p=0.028). Stress hyperglycemia was a predictor of acute kidney injury, ICU admission, and mortality in non-diabetic patients but not those with a history of diabetes. While controlling for age, sex, and chronic kidney disease, patients with stress hyperglycemia who did not have a history of diabetes were at a 2-fold greater risk of AKI (OR:1.65, 95%CI: 1.10, 2.49), ICU admission (OR:2.32, 95%CI 1.58, 3.39) and mortality (OR: 2.22, 95%CI 1.25, 3.96). Acute kidney injury mediated the relationship between hyperglycemia and COVID-19 mortality by 52%.In conclusion, stress hyperglycemia is common in non-diabetic adult patients hospitalized for COVID-19 and is a risk factor for poor prognosis and mortality. Routine screening of stress hyperglycemia should inform risk stratification and guide precise treatment strategies to optimize survival.
    • Stress hyperglycemia is common in hospitalized patients and often is associated with poor outcomes. In patients with coronavirus disease 2019 (COVID-19), the incidence of stress hyperglycemia remains unknown. In this dissertation, I aimed to estimate the incidence of stress hyperglycemia in non-diabetic patients hospitalized for COVID-19 and to characterize the association of stress hyperglycemia with mortality. I did this in two major studies:
    • I first conducted a systematic review and meta-analysis to assess the epidemiology of COVID-19 and stress hyperglycemia. PubMed, SCOPUS, OVID, and Cochrane Library databases and preprint repositories were searched from January 1, 2020, to April 1, 2021. Random-effects models were used to estimate the pooled incidence of stress hyperglycemia and its association with mortality. Sub-group analysis was conducted to explore reasons for heterogeneity. Eight cohort studies were identified that included 3,075 patients from three continents. The median age and mean body mass index were 59 years and 28 kg/m2, respectively, and 60% were male. The pooled incidence of stress hyperglycemia was 34%(95% confidence interval (CI): 23%-48%) in non-diabetic patients. Stress hyperglycemia was associated with a 2-fold higher risk of ventilation (risk ratio (RR)= 2.01, 95% CI=1.30-3.09) and mortality (RR= 2.11, 95%CI= 1.24-3.59).
    • Secondly, I conducted a retrospective cohort study on adult patients in which I evaluated the causal link of stress hyperglycemia and acute kidney injury (AKI) in COVID-19 mortality. The records of 1,372 adult patients admitted to Penn State Milton S. Hershey Medical Center for a diagnosis of COVID-19 who had at least one glucose measurement within 48 hours of admission were reviewed. Diabetes was an effect modifier in the association between hyperglycemia and COVID-19 (p=0.028). Stress hyperglycemia was a predictor of acute kidney injury, ICU admission, and mortality in non-diabetic patients but not those with a history of diabetes. While controlling for age, sex, and chronic kidney disease, patients with stress hyperglycemia who did not have a history of diabetes were at a 2-fold greater risk of AKI (OR:1.65, 95%CI: 1.10, 2.49), ICU admission (OR:2.32, 95%CI 1.58, 3.39) and mortality (OR: 2.22, 95%CI 1.25, 3.96). Acute kidney injury mediated the relationship between hyperglycemia and COVID-19 mortality by 52%.
    • In conclusion, stress hyperglycemia is common in non-diabetic adult patients hospitalized for COVID-19 and is a risk factor for poor prognosis and mortality. Routine screening of stress hyperglycemia should inform risk stratification and guide precise treatment strategies to optimize survival.