Glycemic Gap Predicts Mortality in a Large Multicenter Cohort Hospitalized With COVID-19

Context Diabetes or hyperglycemia at admission are established risk factors for adverse outcomes during hospitalization for COVID-19, but the impact of prior glycemic control is not clear. Objective We aimed to examine the associations between admission variables, including glycemic gap, and adverse clinical outcomes in patients hospitalized with COVID-19 infection. Methods We examined the relationship between clinical predictors, including acute and chronic glycemia, and clinical outcomes, including intensive care unit (ICU) admission, mechanical ventilation (MV), and mortality among 1786 individuals with diabetes or hyperglycemia (glucose > 10 mmol/L twice in 24 hours) who were admitted from March 2020 through February 2021 with COVID-19 infection at 5 university hospitals in the eastern United States. Results The cohort was 51.3% male, 53.3% White, 18.8% Black, 29.0% Hispanic, with age = 65.6 +/- 14.4 years, BMI = 31.5 +/- 7.9 kg/m(2), glucose = 12.0 +/- 7.5 mmol/L [216 +/- 135 mg/dL], and HbA(1c) = 8.07% +/- 2.25%. During hospitalization, 38.9% were admitted to the ICU, 22.9% received MV, and 10.6% died. Age (P < 0.001) and admission glucose (P = 0.014) but not HbA(1c) were associated with increased risk of mortality. Glycemic gap, defined as admission glucose minus estimated average glucose based on HbA(1c), was a stronger predictor of mortality than either admission glucose or HbA(1c) alone (OR = 1.040 [95% CI: 1.019, 1.061] per mmol/L, P < 0.001). In an adjusted multivariable model, glycemic gap, age, BMI, and diabetic ketoacidosis on admission were associated with increased mortality, while higher estimated glomerular filtration rate (eGFR) and use of any diabetes medication were associated with lower mortality (P < 0.001). Conclusion Relative hyperglycemia, as measured by the admission glycemic gap, is an important marker of mortality risk in COVID-19.