J-shaped associations and joint effects of fasting glucose with inflammation and cytokines on COVID-19 mortality. (September 2022)

• Record Type: Journal Article
• Authors: Lai, Xuefeng; Deng, Shan; Hu, Lizhi; Chen, Ru; Chen, Min; Liang, Minglu; Hou, Jian; Huang, Kai; Zhang, Xiaomin
• Is Part Of: International journal of infectious diseases. Volume 122(2022)
• Page Start: 285
• Page End: 294
• Publication Date: 2022-09
• Subjects: Fasting Blood Glucose -- Inflammation -- Cytokines -- Dose-Response -- Joint Effects -- COVID-19; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2022.05.060
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: J-shaped association existed between fasting glucose (FBG) and COVID-19 mortality FBG had strong joint effect with inflammation on COVID-19 mortality The role of hyperglycemia on COVID-19 mortality may have been underestimated Abstract: Objectives: The aim of this study was to investigate the dose-response relationship of admission fasting glucose (FBG) with corona virus disease 2019 (COVID-19) mortality and to further evaluate potential interactions of hyperglycemia with inflammation and hypercoagulation on COVID-19 outcomes. Methods: This retrospective study included 2555 consecutively hospitalized patients with COVID-19, until death or discharge, in Wuhan Union hospital between January 1 and April 9, 2020. The poor early outcomes included admission to intensive care unit, intubation, and deaths occurring within 28 days. We used splines nested in Cox regression to visualize dose-response associations and generalized additive models to fit three-dimensional (3D) trend plots for joint effects of FBG with markers of inflammation and coagulation. Results: J-shaped associations existed between hospitalized mortality or poor early outcomes and FBG with a nadir at 5 mmol/L, which were more evident in women. 3D plots demonstrated significant joint effect trends, and patients with hyperglycemia and high neutrophil-lymphocyte ratio, C-reactive protein, lactate dehydrogenase, procalcitonin, d-dimer, and interleukin-6 had 7.4-25.3-fold risks; the proportions of joint associations attributed to additive interactions reached 30% to 54%. Conclusions: FBG was associated with hospitalized mortality and poor early outcomes in a J-shaped manner, and a combination of hyperglycemia, inflammation, hypercoagulation, and cytokines conferred a dramatically higher risk.