Impacto de hiperglucemia en pronóstico de hospitalizados por neumonía grave en COVID-19 / Impact of hyperglycemia on the prognosis of patients hospitalized for severe pneumonia in COVID-19
Palabras clave:
Infecciones por coronavirus, COVID-19, Hiperglucemia, Diabetes Mellitus Tipo 2, Mortalidad / Coronavirus Infections, Hyperglycemia, Diabetes Mellitus, Type 2, MortalityResumen
Resumen
Introducción: el adecuado control glucémico mejora el pronóstico de pacientes hospitalizados por neumonía asociada a COVID-19 grave.
Objetivo: evaluar el impacto de la hiperglucemia (HG) sobre el pronóstico de pacientes hospitalizados por neumonía grave asociada a COVID-19 en no vacunados.
Material y métodos: estudio de cohorte prospectivo. Se incluyeron pacientes hospitalizados de agosto de 2020 a febrero de 2021, con neumonía grave por COVID-19, no vacunados contra SARS-CoV-2. Los datos fueron recolectados desde el ingreso hasta el egreso. Se empleó estadística descriptiva y analítica de acuerdo con la distribución de datos. Se construyeron curvas ROC para determinar los puntos de corte de mayor rendimiento predictivo para HG y mortalidad, con el programa IBM SPSS, versión 25.
Resultados: se incluyeron 103 pacientes, 32% mujeres, 68% hombres, edad 57 ± 13 años; 58% ingresaron con HG (191, IQR 152-300 mg/dL) y 42% en normoglucemia (NG < 126 mg/dL). La mortalidad fue mayor en HG al ingreso 34 (56.7%) que en NG 13 (30.2%) (p = 0.008). La HG se asoció con diabetes mellitus 2 y neutrofilia (p < 0.05). El riesgo de muerte se incrementó 1.558 veces (IC 95% 1.118- 2.172) si la HG fue al ingreso y 1.43 veces (IC 95% 1.14- 1.79) durante la hospitalización. Mantener NG durante todo el internamiento contribuyó de manera independiente a la sobrevida (RR 0.083 [IC 95% 0.012-0.571], p = 0.011).
Conclusión: la HG impacta significativamente el pronóstico al incrementar en más de 50% la mortalidad durante la hospitalización por COVID-19.
Abstract
Background: Adequate glycemic control improves the prognosis of patients hospitalized for pneumonia associated with severe COVID-19.
Objective: To evaluate the impact of hyperglycemia (HG) on the prognosis of patients hospitalized for severe pneumonia associated with COVID-19 in unvaccinated patients.
Material and methods: Prospective cohort study. We included patients hospitalized from August 2020 to February 2021, with severe COVID-19 pneumonia, not vaccinated against SARS-CoV-2. Data was collected from admission to discharge. We used descriptive and analytical statistics according to the data distribution. ROC curves were used to determine the cut-off points with the highest predictive performance for HG and mortality, with the IBM SPSS program, version 25.
Results: We included 103 patients, 32% women, 68% men, age 57 ± 13 years; 58% were admitted with HG (191, IQR 152-300 mg/dL) and 42% with normoglycemia (NG < 126 mg/dL). Mortality was higher in HG at admission 34 (56.7%) than in NG 13 (30.2%) (p = 0.008). HG was associated with diabetes mellitus 2 and neutrophilia (p < 0.05). The risk of death increases 1.558 times (95% CI 1.118-2.172) if HG is at admission and 1.43 times (95% CI 1.14-1.79) during hospitalization. Maintaining NG throughout the hospitalization contributed independently to survival (RR = 0.083 [95% CI 0.012-0.571], p = 0.011).
Conclusion: HG significantly impacts prognosis by increasing mortality more than 50% during hospitalization for COVID-19.
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Referencias
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