Some characteristics of hyperglycaemic crisis differ between patients with and without COVID-19 at a safety-net hospital in a cross-sectional study
AbstractObjective To compare patients with DKA, hyperglycaemic hyperosmolar syndrome (HHS), or mixed DKA-HHS and COVID-19 [COVID (+)] to COVID-19-negative (−) [COVID (−)] patients with DKA/HHS from a low-income, racially/ethnically diverse catchment area.Methods A cross-sectional study was conducted...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2021-01-01
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| Series: | Annals of Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/07853890.2021.1975042 |
| _version_ | 1797385673131425792 |
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| author | Arnav Shah Andrew Deak Shaneisha Allen Elayna Silfani Christina Koppin Yaara Zisman-Ilani Imali Sirisena Christina Rose Daniel Rubin |
| author_facet | Arnav Shah Andrew Deak Shaneisha Allen Elayna Silfani Christina Koppin Yaara Zisman-Ilani Imali Sirisena Christina Rose Daniel Rubin |
| author_sort | Arnav Shah |
| collection | DOAJ |
| description | AbstractObjective To compare patients with DKA, hyperglycaemic hyperosmolar syndrome (HHS), or mixed DKA-HHS and COVID-19 [COVID (+)] to COVID-19-negative (−) [COVID (−)] patients with DKA/HHS from a low-income, racially/ethnically diverse catchment area.Methods A cross-sectional study was conducted with patients admitted to an urban academic medical center between 1 March and 30 July 2020. Eligible patients met lab criteria for either DKA or HHS. Mixed DKA-HHS was defined as meeting all criteria for either DKA or HHS with at least 1 criterion for the other diagnosis.Results A total of 82 participants were stratified by COVID-19 status and type of hyperglycaemic crisis [26 COVID (+) and 56 COVID (−)]. A majority were either Black or Hispanic. Compared with COVID (−) patients, COVID (+) patients were older, more Hispanic and more likely to have type 2 diabetes (T2D, 73% vs 48%, p < .01). COVID(+) patients had a higher mean pH (7.25 ± 0.10 vs 7.16 ± 0.16, p < .01) and lower anion gap (18.7 ± 5.7 vs 22.7 ± 6.9, p = .01) than COVID (−) patients. COVID (+) patients were given less intravenous fluids in the first 24 h (2.8 ± 1.9 vs 4.2 ± 2.4 L, p = .01) and were more likely to receive glucocorticoids (95% vs. 11%, p < .01). COVID (+) patients may have taken longer to resolve their hyperglycaemic crisis (53.3 ± 64.8 vs 28.8 ± 27.5 h, p = .09) and may have experienced more hypoglycaemia <3.9 mmol/L (35% vs 19%, p = .09). COVID (+) patients had a higher length of hospital stay (LOS, 14.8 ± 14.9 vs 6.5 ± 6.0 days, p = .01) and in-hospital mortality (27% vs 7%, p = .02).Discussion Compared with COVID (−) patients, COVID (+) patients with DKA/HHS are more likely to have T2D. Despite less severe metabolic acidosis, COVID (+) patients may require more time to resolve the hyperglycaemic crisis and experience more hypoglycaemia while suffering greater LOS and risk of mortality. Larger studies are needed to examine whether differences in management between COVID (+) and (−) patients affect outcomes with DKA/HHS. |
| first_indexed | 2024-03-08T21:57:41Z |
| format | Article |
| id | doaj.art-03ff2b8881ba4bb4aae0aeee62916db3 |
| institution | Directory Open Access Journal |
| issn | 0785-3890 1365-2060 |
| language | English |
| last_indexed | 2024-03-08T21:57:41Z |
| publishDate | 2021-01-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Annals of Medicine |
| spelling | doaj.art-03ff2b8881ba4bb4aae0aeee62916db32023-12-19T16:46:26ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602021-01-015311642164510.1080/07853890.2021.1975042Some characteristics of hyperglycaemic crisis differ between patients with and without COVID-19 at a safety-net hospital in a cross-sectional studyArnav Shah0Andrew Deak1Shaneisha Allen2Elayna Silfani3Christina Koppin4Yaara Zisman-Ilani5Imali Sirisena6Christina Rose7Daniel Rubin8Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USALewis Katz School of Medicine, Temple University, Philadelphia, PA, USASection of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USASchool of Pharmacy, Temple University, Philadelphia, PA, USALewis Katz School of Medicine, Temple University, Philadelphia, PA, USADepartment of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USASection of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USASchool of Pharmacy, Temple University, Philadelphia, PA, USASection of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USAAbstractObjective To compare patients with DKA, hyperglycaemic hyperosmolar syndrome (HHS), or mixed DKA-HHS and COVID-19 [COVID (+)] to COVID-19-negative (−) [COVID (−)] patients with DKA/HHS from a low-income, racially/ethnically diverse catchment area.Methods A cross-sectional study was conducted with patients admitted to an urban academic medical center between 1 March and 30 July 2020. Eligible patients met lab criteria for either DKA or HHS. Mixed DKA-HHS was defined as meeting all criteria for either DKA or HHS with at least 1 criterion for the other diagnosis.Results A total of 82 participants were stratified by COVID-19 status and type of hyperglycaemic crisis [26 COVID (+) and 56 COVID (−)]. A majority were either Black or Hispanic. Compared with COVID (−) patients, COVID (+) patients were older, more Hispanic and more likely to have type 2 diabetes (T2D, 73% vs 48%, p < .01). COVID(+) patients had a higher mean pH (7.25 ± 0.10 vs 7.16 ± 0.16, p < .01) and lower anion gap (18.7 ± 5.7 vs 22.7 ± 6.9, p = .01) than COVID (−) patients. COVID (+) patients were given less intravenous fluids in the first 24 h (2.8 ± 1.9 vs 4.2 ± 2.4 L, p = .01) and were more likely to receive glucocorticoids (95% vs. 11%, p < .01). COVID (+) patients may have taken longer to resolve their hyperglycaemic crisis (53.3 ± 64.8 vs 28.8 ± 27.5 h, p = .09) and may have experienced more hypoglycaemia <3.9 mmol/L (35% vs 19%, p = .09). COVID (+) patients had a higher length of hospital stay (LOS, 14.8 ± 14.9 vs 6.5 ± 6.0 days, p = .01) and in-hospital mortality (27% vs 7%, p = .02).Discussion Compared with COVID (−) patients, COVID (+) patients with DKA/HHS are more likely to have T2D. Despite less severe metabolic acidosis, COVID (+) patients may require more time to resolve the hyperglycaemic crisis and experience more hypoglycaemia while suffering greater LOS and risk of mortality. Larger studies are needed to examine whether differences in management between COVID (+) and (−) patients affect outcomes with DKA/HHS.https://www.tandfonline.com/doi/10.1080/07853890.2021.1975042COVID-19hyperglycaemic emergenciesdiabetic ketoacidosishyperglycaemic hyperosmolar syndrome |
| spellingShingle | Arnav Shah Andrew Deak Shaneisha Allen Elayna Silfani Christina Koppin Yaara Zisman-Ilani Imali Sirisena Christina Rose Daniel Rubin Some characteristics of hyperglycaemic crisis differ between patients with and without COVID-19 at a safety-net hospital in a cross-sectional study Annals of Medicine COVID-19 hyperglycaemic emergencies diabetic ketoacidosis hyperglycaemic hyperosmolar syndrome |
| title | Some characteristics of hyperglycaemic crisis differ between patients with and without COVID-19 at a safety-net hospital in a cross-sectional study |
| title_full | Some characteristics of hyperglycaemic crisis differ between patients with and without COVID-19 at a safety-net hospital in a cross-sectional study |
| title_fullStr | Some characteristics of hyperglycaemic crisis differ between patients with and without COVID-19 at a safety-net hospital in a cross-sectional study |
| title_full_unstemmed | Some characteristics of hyperglycaemic crisis differ between patients with and without COVID-19 at a safety-net hospital in a cross-sectional study |
| title_short | Some characteristics of hyperglycaemic crisis differ between patients with and without COVID-19 at a safety-net hospital in a cross-sectional study |
| title_sort | some characteristics of hyperglycaemic crisis differ between patients with and without covid 19 at a safety net hospital in a cross sectional study |
| topic | COVID-19 hyperglycaemic emergencies diabetic ketoacidosis hyperglycaemic hyperosmolar syndrome |
| url | https://www.tandfonline.com/doi/10.1080/07853890.2021.1975042 |
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