BACKGROUND

Patients with diabetes mellitus are more vulnerable to COVID-19 infection and exhibit more severe manifestations and worse clinical outcomes. Since the start of the COVID-19 pandemic, there has been a noted increase in the incidence of hyperglycemic crises in hospitals, and this involves both patients with COVID-19 infection and patients without COVID-19 infection. Aside from COVID-19 infection, the factors that are responsible for this increase in incidence of hyperglycemic crises may include reduced medical services, fear of seeking health care, and psychosocial factors. In the Philippines, there is a lack of data comparing these two subsets of patients. This study aims to give a comparison of the clinical outcomes of COVID-19 positive and COVID-19 negative patients who presented with hyperglycemic crises during the COVID-19 pandemic.

METHODS

This is a retrospective cohort study of adult patients with hyperglycemic crisis on admission from March 1, 2020 to February 28, 2022 at the St. Luke’s Medical Center Global City. Their medical records were reviewed to determine their clinical background, presenting clinical manifestations, non-COVID-19 acute conditions, biochemical and clinical parameters, treatment regimen, and clinical outcomes.

RESULTS

We analyzed 15 COVID-19 positive patients and 38 COVID-19 negative patients who had a hyperglycemic crisis on admission. Patients who were COVID-19 positive were found to be significantly older (mean age of 59 years) than COVID-19 negative patients (mean age of 46 years) (p = 0.0197). The COVID-19 positive group also had a significantly higher proportion of patients with malignancy (p = 0.031), urinary tract infection on admission (p = 0.039), and more frequently received steroids concurrent with treatment for hyperglycemic crisis (p = 0.002). The COVID-19 positive group had a significantly higher proportion of in-hospital mortality before resolution of hyperglycemic crisis (p = 0.008), as well as development of acute respiratory failure (p = 0.000). On the other hand, the COVID-19 negative group had a significantly higher proportion of patients who developed acute kidney injury during hospitalization (p = 0.026). There were no statistically significant differences in terms of time to resolution of DKA, development of hypoglycemia or hypokalemia, length of ICU and hospital stay, or development of cardiac decompensation and acute liver injury.

CONCLUSION

Patients hospitalized with hyperglycemic crisis who also had a COVID-19 infection had a higher in-hospital mortality rate than patients who were COVID-19 negative. Contributing factors may include older age and concurrent steroid treatment, which were more frequent among patients with COVID-19 infection. Aggressive treatment of hyperglycemic crisis in COVID-19 patients is warranted. Efforts to prevent hyperglycemic crises should be improved.

Human ; Covid-19