Study of Patients’ Characteristics and Mutual Impact Between Covid-19 and Hyperglycemia at a Community Hospital in Central Brooklyn

摘要

Background: Studies have shown that poorly-controlled hyperglycemia worsens the outcomes in patients with COVID-19 (C-19) and C-19 may damage pancreatic islets via ACE2 receptors causing acute hyperglycemia. The major population we serve at Kingsbrook Jewish Medical Center (KJMC) are underprivileged with many of them having multiple comorbidities. Methods: This is a retrospective study wherein patients, admitted from February 2020 to April 2020 with hyperglycemia, were selected and divided into 2 groups based on presence or absence of C-19. Data include demographics, comorbidities, blood glucose level, serum osmolality, serum bicarbonate, anion gap, acute kidney injury (AKI), serum creatinine, ICU admission, length of stay (LOS) and mortality. Data were analyzed using descriptive study and T-test. Results: 100 patients were included in the C-19 group (CG) and 88 patients were included in the Non C-19 group (NCG). Major comorbidities were similar in both groups including HTN, DM, CKD followed by ESRD. Mean age of patients (years) was 65.68 in CG and 61.17 in NCG. 61% were male in CG and 53.41% were male in NCG. 16% and 9% developed DKA and HHS in CG, and 13.64% and 6.82% developed DKA and HHS in NCG respectively. 15% in CG had combined DKA & HHS and 3.41% had same in NCG. Mean blood glucose level (mg/dl) was 541.6 in CG and 460.0 in NCG (p=0.03). Mean serum osmolality (mOsm/kg) was 335.7 (SD±41.01) in CG and 317.1 (SD±30.54) in NCG (p=0.01). Mean serum bicarbonate (mEq/L) was 17.73 (SD±6.31) in CG and 21.46 (SD±5.94) in NCG (p<0.0001). Mean anion gap was 17.93 (SD±7.6) in CG and 13.10 (SD±7.2) in NCG (p<0.0001). 56% in CG and 37% in NCG developed AKI respectively (p=0.01). Mean serum creatinine (mg/dl) was 4.22 in CG and 1.65 in NCG (p=0.004). 55% of CG were admitted to ICU and 34% of NCG were admitted to ICU (p=0.003). Median LOS (days) in discharged patients was 8 in CG and 5 in NCG (p=0.02). Mortality was 40% in CG and 3.41% in NCG (p<0.0001). 12 patients in CG and 2 patients in NCG developed new-onset diabetes. In the subset of DKA, interestingly, mean age (years) was 61.63 (SD±17.73) in CG and 39.67 in NCG (SD±13.39) (p=0.001). Conclusion: In our study, patients in the CG carry worse laboratory parameters, unfavorable clinical outcomes and strikingly higher mortality. We discovered increased incidence of new-onset diabetes and elderly DKA in CG. In an inner city population like ours, the burden of DM with significant social and health care disparities is quite severe. Diabetic patients with concurrent C-19 infection can have particularly negative outcomes and C-19 possibly damages the pancreatic islets resulting in acute hyperglycemic crisis. Further research on larger population is required. References: (1)https://dx.doi.org/10.1016%2Fj.diabres.2020.108142(2) https://doi.org/10.2337/dc20-0723(3)https://www.nejm.org/doi/full/10.1056/NEJMc2018688