Dysglycemias in patients admitted to ICUs with severe acute respiratory syndrome due to COVID-19 versus other causes - a cohort study

doi:10.1186/s12890-023-02439-y

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BMC Pulm Med. 2023; 23: 173.

Published online 2023 May 16. doi: 10.1186/s12890-023-02439-y

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Table 2

Influence of COVID-19 on each of the parameters of glycemic abnormality unadjusted and adjusted for the variables sex, history of diabetes, presumed obesity, age, APACHE II scores, SOFA scores, CRP levels, and corticosteroid use

Factors associated with highest glucose level on admission	n^$	e ^Coef. (95% CI) unadjusted*	p value^§	n^$$	e ^Coef. (95% CI) adjusted**	p value^§
COVID-19 ^a	837	1.144 (1.054–1.241)	0.001	833	1.034 (0.959–1.115)	0.380
Male sex ^b	837	0.939 (0.884–0.999)	0.046		0.981 (0.93–1.035)	0.489
History of diabetes ^c	837	1.518 (1.43–1.611)	<0.001		1.479 (1.395–1.568)	0.000
Presumed obesity ^d	837	1.084 (1.015–1.159)	0.017		1.032 (0.973–1.094)	0.293
Charlson Comorbidity Index	837	1.036 (1.013–1.059)	0,002		-	-
Age	837	1.002 (1–1.003)	0.080		0.997 (0.996–0.999)	0.003
APACHE II scores	837	1.012 (1.009–1.015)	<0.001		1.008 (1.005–1.012)	0.000
SOFA scores in the first 24 h	837	1.034 (1.023–1.046)	<0.001		1.017 (1.005–1.028)	0.005
CRP in the first 24 h	833	1.001 (1.001–1.001)	<0.001		1.000 (1.000–1.001)	0.039
Use of corticosteroids ^f	837	1.180 (1.108–1.257)	<0.001		1.163 (1.099–1.231)	0.000
					BIC: 838.168‡
Factors associated with highest glucose levels during hospitalization	n ^$	e ^Coef. (95% CI) unadjusted*	p value ^§	n ^$$	e ^Coef. (95% CI) adjusted**	p value ^§
COVID-19 ^a	841	1.237 (1.133–1.35)	<0.001	837	1.067 (0.995–1.145)	0.069
Male sex ^b	841	0.959 (0.898–1.025)	0.217		-	-
History of diabetes ^c	841	1.583 (1.485–1.688)	<0.001		1.524 (1.444–1.609)	0.000
Presumed obesity ^d	841	1.177 (1.096–1.264)	<0.001		1.098 (1.039–1.161)	0.001
Charlson Comorbidity Index	841	1.061 (1.035–1.086)	<0.001		-	-
Age	841	1.004 (1.002–1.006)	<0.001		0.999 (0.998–1.001)	0.369
APACHE II scores	841	1.014 (1.011–1.018)	<0.001		1.003 (1–1.006)	0.060
Nosocomial infection ^e	841	1.57 (1.455–1.695)	<0.001		1.376 (1.29–1.468)	0.000
Mean SOFA during ICU stay	841	1.068 (1.058–1.079)	<0.001		1.045 (1.032–1.057)	0.000
Mean CRP during ICU stay	837	1.002 (1.001–1.002)	<0.001		1.000 (1.000–1.000)	0.745
Use of corticosteroids ^f	837	1.211 (1.131–1.296)	<0.001		1.172 (1.111–1.236)	0.000
					BIC: 741.262‡
Factors associated with mean glycemic levels during hospitalization	n ^$	e ^Coef. (95% CI) unadjusted*	p value ^§	n ^$$	e ^Coef. (95% CI) adjusted**	p value ^§
COVID-19 ^a	841	1.121 (1.054–1.191)	<0.001	837	1.029 (0.977–1.084)	0.284
Male sex ^b	841	0.977 (0.933–1.023)	0.312		-	-
History of diabetes ^c	841	1.432 (1.371–1.495)	<0.001		1.398 (1.342–1.455)	<0.001
Presumed obesity ^d	841	1.123 (1.069–1.18)	<0.001		1.078 (1.035–1.123)	<0.001
Charlson Comorbidity Index	841	1.044 (1.027–1.062)	<0.001		-	-
Age	841	1.003 (1.001–1.004)	<0.001		0.999 (0.998–1.001)	0.267
APACHE II	841	1.009 (1.007–1.012)	<0.001		1.004 (1.001–1.006)	0.003
Nosocomial infection ^e	841	1.185 (1.121–1.254)	<0.001		1.101 (1.049–1.155)	<0.001
Mean SOFA during ICU stay	841	1.035 (1.028–1.043)	<0.001		1.02 (1.011–1.029)	<0.001
Mean CRP during ICU stay	837	1.001 (1.001–1.001)	<0.001		1.000 (1.000–1.000)	0.466
Use of corticosteroids ^f	837	1.104 (1.053–1.158)	<0.001		1.089 (1.047–1.134)	<0.001
					BIC: 252.794‡
Factors associated with % of days with hyperglycemia (≥180 mg/dL)	n ^$	Coef. (95% CI) unadjusted ^#	p value ^§	n ^$$	Coef. (95% CI) adjusted ^##	p value ^§
COVID-19 ^a	841	13.528 (6.44–20.616)	<0.001	837	3.233 (-2.813–9.28)	0.295
Male sex ^b	841	-3.805 (-9.13–1.519)	0.161		0.176 (-4.178–4.53)	0.937
History of diabetes ^c	841	41.881 (36.895–46.867)	<0.001		39.565 (34.869–44.261)	0.000
Presumed obesity ^d	841	9.123 (3.364–14.881)	0.002		4.271 (-0.483–9.026)	0.078
Charlson Comorbidity Index	841	5.365 (3.437–7.294)	<0.001		-	-
Age	841	0.328 (0.17–0.487)	<0.001		-0.051 (-0.196–0.094)	0.490
APACHE II scores	841	1.036 (0.774–1.298)	<0.001		0.356 (0.075–0.636)	0.013
Nosocomial infection ^e	841	20.309 (13.848–26.77)	<0.001		12.01 (6.443–17.576)	0.000
Mean SOFA during ICU stay	841	3.965 (3.121–4.808)	<0.001		2.164 (1.131–3.197)	0.000
Mean CRP during ICU stay	837	0.107 (0.074–0.139)	<0.001		0.023 (-0.009–0.055)	0.163
Use of corticosteroid ^f	837	12.994 (7.495–18.493)	<0.001		12.054 (7.443–16.665)	0.000
					BIC: 8208.738‡
Factors associated with mean glucose variability (CV %) during ICU stay	n ^$	Coef. (95% CI) unadjusted ^#	p value ^§	n ^$$	Coef. (95% CI) adjusted ^##	p value ^§
COVID-19 ^a	765	4.243 (1.033–7.454)	0.010	762	1.999 (-0.773–4.771)	0.158
Male sex ^b	765	-3.114 (-5.392 - -0.837)	0.007		-0.716 (-2.642–1.21)	0.466
History of diabetes ^c	765	16.237 (14.071–18.404)	<0.001		15.04 (12.978–17.102)	<0.001
Presumed obesity ^d	765	-1.634 (-4.114–0.847)	0.202		-	-
Charlson Comorbidity Index	765	3.279 (2.44–4.119)	<0.001		-	-
Age	765	0.204 (0.136–0.272)	<0.001		0.011 (-0.053–0.076)	0.730
APACHE II scores	765	0.527 (0.413–0.64)	<0.001		0.252 (0.127–0.377)	<0.001
Nosocomial infection ^e	765	4.282 (1.532–7.033)	0.002		1.186 (-1.216–3.588)	0.333
Mean SOFA during ICU stay	765	1.678 (1.303–2.052)	<0.001		1.012 (0.545–1.479)	<0.001
Mean CRP during ICU stay	762	0.033 (0.019–0.047)	<0.001		-0.003 (-0.017–0.012)	0.722
Use of corticosteroid ^f	765	4.197 (1.744–6.65)	<0.001		4.098 (2.018–6.178)	<0.001
					BIC: 6153.797‡

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Abbreviations: APACHE II, Acute Physiology and Chronic Health Evaluation II; SOFA: Sequential Organ Failure Assessment; CRP: C-reactive protein (mg/L)

Reference categories: ^anon-COVID-19; ^bfemale sex; ^cabsence of history of known diabetes; ^dabsence of presumed obesity; ^eabsence of nosocomial infection; ^fno use of corticosteroids during ICU stay

*Exponentiated linear regression coefficient (e^Coef.) and 95% confidence interval (95% IC) of the univariate log-linear regression model

**Exponentiated linear regression coefficient (e^Coef.) and 95% confidence interval (95% IC) of the multivariate log-linear regression model

^#Linear regression coefficient (Coef.) and 95% confidence interval (95% IC) of the univariate log-linear regression model

^##Linear regression coefficient (Coef.) and 95% confidence interval (95% IC) of the multivariate log-linear regression model

^$number of cases (n) included in each univariate model. ^$$number of cases (n) included in the multivariate model

^§Wald test p value, p<0.05 indicates statistical significance

^‡Bayesian information criterion (BIC) of the multivariate generalized linear model, representative of the quality of the model given its explanatory potential, with the lower the BIC, the more the model is able to explain the dependent variable