Patients with diabetes are vulnerable and highly susceptible to contracting COVID-19. Stress hyperglycemia ratio (SHR) may provide prognostic information in hospitalized patients. It is debatable whether stress hyperglycemia directly leads to poor outcomes, or is simply a marker of increased stress and inflammation.

This study investigates whether high SHR is associated with poor clinical outcomes among patients with type 2 diabetes mellitus (T2DM) and moderate to critical COVID-19 infection. Moreover, this study aims to compare high SHR versus absolute hyperglycemia as a predictor of poor outcomes.

A chart review was conducted on 146 COVID-19 patients with T2DM from March 2020 to December 2021. The area under the receiver operating curve was conducted to categorize SHR into low and high levels. The association of high SHR levels and absolute hyperglycemia with outcomes was analyzed using the regression analysis. Survival analysis was also utilized to allow differences in the time when in-hospital mortality occurred.

Patients with high SHR had a significantly higher proportion of mortality and invasive ventilation compared to those with low SHR. High SHR significantly increased the likelihood of invasive ventilation by 16.49 times and mortality hazards by 5.70 times compared to low SHR. Kaplan-Meier survival curves showed that those with high SHR had significantly lower survival rates than those with low SHR. In contrast, the survival estimates between those with and without absolute hyperglycemia were not statistically significant.

High SHR (>1.082) was associated with poorer outcomes, increased invasive mechanical ventilatory support and increased mortality.