Objectives: To describe the clinical characteristics and outcomes of severely ill patients with coronavirus disease 2019, and to investigate the relationship between plasma glucose level and the prognosis of severely ill patients with coronavirus disease 2019.
Methods: We enrolled 52 severely ill patients with coronavirus disease 2019. Among them, 12 cases progressed to critical illness. The clinical and biochemical characteristics of severely and critically ill patients were compared.
Results: Compared with the severely ill patients, critically ill patients had higher white blood cell and neutrophil counts, as well as higher levels of D-dimer, IL-6 and C-reactive protein (all P<0.05). Before treatment, the fasting plasma glucose (FPG) levels were significantly higher in the critically ill patient's group [(10.23±3.71) mmol/L] compared to those in the severely ill patients [(7.12±3.35) mmol/L, P<0.05]. After adjusting for age, gender, and course of the disease, fasting blood glucose at admission (OR=1.308, 95% CI 1.066 to 1.606, P=0.01) and hyperglycemia at admission (OR=29.198, 95% CI 2.903 to 293.639, P=0.004) were closely related to whether severely ill patients progressed to critical patients with coronavirus disease 2019. In our study, 15 (34.8%) of the severely ill and 10 (83.3%) critically ill patients received the steroid treatment. Compared with the severely ill patients, the FPG levels in critically ill patients were higher (P<0.05).
Conclusions: Fasting hyperglycemia at admission is a significant predictor for the prognosis of severely ill patients with coronavirus disease 2019. Closely monitoring and the optimal management of hyperglycemia may improve the prognosis of patients with coronavirus disease 2019.
目的: 探讨重型2019冠状病毒病(coronavirus disease 2019，COVID-19)患者的临床特征和血糖与重型COVID-19预后的关系。方法: 纳入重型COVID-19患者55例，其中12例在诊疗过程中进展为危重型。收集所有患者的临床资料及入院后第1天实验室检查结果，比较重型和危重型COVID-19患者临床特征及血糖的变化。结果: 与重型COVID-19患者比较，危重型患者入院时外周血白细胞、中性粒细胞计数更高，淋巴细胞计数更低，凝血酶原时间延长，D-二聚体水平明显升高，炎症指标如超敏C反应蛋白、IL-6也明显升高(均P<0.05)。危重型COVID-19患者入院空腹血糖为(10.23±3.71) mmol/L，明显高于重型[(7.12±3.35) mmol/L，P<0.05]。在校正年龄、性别和病程后，入院时空腹血糖和高血糖与重型患者是否进展为危重型患者明显相关(分别OR=1.308，95% CI：1.066~1.606，P=0.01；OR=29.198，95% CI：2.903~293.639，P=0.004)。本组15例(34.8%)重型和10例(83.3%)危重型COVID-19患者接受甲基强的松龙静脉注射治疗。在甲基强的松龙治疗过程中，危重型患者空腹血糖始终高于重型患者(P<0.05)。结论: 入院时空腹高血糖是重型COVID-19发展为危重型的重要预测因子，严密监测和加强血糖控制对于降低其危重率和病死率有重要意义。.
Keywords: coronavirus disease 2019; diabetes mellitus; glucose.