Stress Hyperglycemia Ratio as a Prognostic Marker in Diabetic Patients Hospitalized with COVID-19

Mohamed Aon 1, Abdullah Alsaeedi 2, Azeez Alzafiri 2, Abdelrahman Al-Shammari 2, Sherif Taha 1, Omar Al-Shammari 2, Mahmoud Tawakul 2, Jarrah Alshammari 2, Naser Alherz 2, Monerah Alenezi 2, Meshari Eyadah 2, Mariam Aldhafeeri 2, Teflah Alharbi 2, Duaa Alshammari 2, Zaid Alenezi 2, Salem Aldouseri 2, Ebraheem Albazee 2, Mohamed M Ibrahim 3, Ahmed H Aoun 4

Affiliations

07 September 2022

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doi: 10.3390/idr14050073

Abstract

Evidence is conflicting about the diabetes characteristics associated with worse outcome among hospitalized COVID-19 patients. We aimed to assess the role of stress hyperglycemia ratio (SHR) as a prognostic marker among them. In our retrospective cohort study, patients were stratified according to SHR, admission glucose, and glycated hemoglobin tertiles. The primary outcome was a composite endpoint of invasive mechanical ventilation, intensive care unit admission, and in-hospital mortality. The study included 395 patients with a mean age of 59 years, and 50.1% were males. Patients in the third tertile of SHR developed more primary events, and the difference was significant compared to the first tertile (p = 0.038) and close to significance compared to the second tertile (p = 0.054). There was no significant difference in the outcomes across admission glucose and glycated hemoglobin tertiles. A higher SHR tertile was an independent risk factor for the primary outcome (OR, 1.364; 95% CI: 1.014-1.836; p = 0.040) after adjustment for other covariables. In hospitalized COVID-19 diabetic patients, SHR third tertile was significantly associated with worse outcome and death. SHR can be a better prognostic marker compared to admission glucose and glycated hemoglobin. A higher SHR was an independent risk factor for worse outcome and in-hospital mortality.

Keywords: COVID-19; SARS-CoV-2; diabetes mellitus; hyperglycemia; stress hyperglycemia ratio.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1 A flow chart demonstrating selection of the study cohort. Abbreviations: COVID-19, coronavirus disease 2019; DM, diabetes mellitus; HbA1c, glycated hemoglobin.

Figure 1 A flow chart demonstrating selection of the study cohort. Abbreviations: COVID-19, coronavirus disease 2019; DM, diabetes mellitus; HbA1c, glycated hemoglobin.

Figure 2 Risk factors for the primary outcome. For each variable, the black dot represent the odds ratio, and the horizontal line represent the 95% confidence interval. Abbreviations: CI, confidence interval; LDH, lactate dehydrogenase; OR, odds ratio; SHR, stress hyperglycemia ratio.

Figure 2 Risk factors for the primary outcome. For each variable, the black dot represent the odds ratio, and the horizontal line represent the 95% confidence interval. Abbreviations: CI, confidence interval; LDH, lactate dehydrogenase; OR, odds ratio; SHR, stress hyperglycemia ratio.

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