High admission blood glucose independently predicts poor prognosis in COVID-19 patients: A systematic review and dose-response meta-analysis

Gilbert Lazarus, Jessica Audrey, Vincent Kharisma Wangsaputra, Alice Tamara, Dicky L Tahapary, Gilbert Lazarus, Jessica Audrey, Vincent Kharisma Wangsaputra, Alice Tamara, Dicky L Tahapary

Abstract

Aims: To investigate the prognostic value of admission blood glucose (BG) in predicting COVID-19 outcomes, including poor composite outcomes (mortality/severity), mortality, and severity.

Methods: Eligible studies evaluating the association between admission fasting BG (FBG) and random BG (RBG) levels with COVID-19 outcomes were included and assessed for risk of bias with the Quality in Prognosis Studies tool. Random-effects dose-response meta-analysis was conducted to investigate potential linear or non-linear exposure-response gradient.

Results: The search yielded 35 studies involving a total of 14,502 patients. We discovered independent association between admission FBG and poor COVID-19 prognosis. Furthermore, we demonstrated non-linear relationship between admission FBG and severity (Pnon-linearity < 0.001), where each 1 mmol/L increase augmented the risk of severity by 33% (risk ratio 1.33 [95% CI: 1.26-1.40]). Albeit exhibiting similar trends, study scarcity limited the evidence strength on the independent prognostic value of admission RBG. GRADE assessment yielded high-quality evidence for the association between admission FBG and COVID-19 severity, and moderate-quality evidence for its association with mortality and poor outcomes.

Conclusion: High admission FBG level independently predicted poor COVID-19 prognosis. Further research to confirm the prognostic value of admission RBG and to ascertain the estimated dose-response risk between admission FBG and COVID-19 severity are required.

Keywords: Blood glucose; COVID-19; Fasting; Patient admission; Prognosis.

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Copyright © 2020 Elsevier B.V. All rights reserved.

Figures

Fig. 1
Fig. 1
Diagram flow illustrating the literature search process and results. CENTRAL, Cochrane Central Register of Controlled Trials; CINAHL, Cumulative Index to Nursing and Allied Health Literature. WHO, World Health Organization.
Fig. 2
Fig. 2
Risk of bias graph summarizing the results of each risk of bias item in percentages across all studies.
Fig. 3
Fig. 3
Pooled adjusted effects of high vs low meta-analysis comparing the association between (A) admission FBG and poor composite outcome, (B) admission FBG and mortality, (C) admission FBG and severity, and (D) admission RBG and ICU admission. FBG, fasting blood glucose; ICU, intensive care unit; RBG, random blood glucose.
Fig. 4
Fig. 4
Results of dose-response meta-analysis illustrating linear trend between admission FBG and (A) poor outcome, (B) mortality, and (C) severity; and (D) non-linear trend between admission FBG and severity. In Figure C, darker area represents 95% confidence interval of non-linear trend, while lighter area represents 95% confidence interval of linear trend. FBG, fasting blood glucose.

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