Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2022; 13(7): 543-552
Published online Jul 15, 2022. doi: 10.4239/wjd.v13.i7.543
Elevated levels of fructosamine are independently associated with SARS-CoV-2 reinfection: A 12-mo follow-up study
Xiao-Yan Huang, Li-Juan Yang, Xiang Hu, Xing-Xing Zhang, Xiao Gu, Xue-Jiang Gu, Zhi-Ying He, Lin-Jia Du
Xiao-Yan Huang, Li-Juan Yang, Xiang Hu, Xing-Xing Zhang, Xiao Gu, Lin-Jia Du, Zhi-Ying He, Xue-Jiang Gu, Department of Endocrine and Metabolic Disease, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Xiao-Yan Huang, Department of Endocrine and Metabolic Disease, Yueqing People’s Hospital, Affiliated Hospital of Wenzhou Medical University, Wenzhou 325600, Zhejiang Province, China
Author contributions: Gu XJ was the guarantor and designed the study; Huang XY and Hu X participated in the acquisition, analysis, interpretation of the data, and drafted the initial manuscript; Yang LY, Zhang XX, Gu X, Du LJ, and He ZY revised the article critically for important intellectual content.
Institutional review board statement: The study protocol was approved by the Ethics Committee of Yueqing People’s Hospital, Affiliated Hospital of Wenzhou Medical University (No. YQYY202100033).
Informed consent statement: The informed consent statement was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xue-Jiang Gu, MMed, Chief Doctor, Department of Endocrine and Metabolic Disease, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Nanbaixiang Street, Ouhai District, Wenzhou 325000, Zhejiang Province, China. guxuejiang@wmu.edu.cn
Received: December 8, 2021
Peer-review started: December 8, 2021
First decision: April 18, 2022
Revised: April 29, 2022
Accepted: June 13, 2022
Article in press: June 13, 2022
Published online: July 15, 2022
Processing time: 214 Days and 14.9 Hours
Abstract
BACKGROUND

The association between blood levels of fructosamine (FMN) and recurrent coronavirus disease 2019 (COVID-19) is currently unclear.

AIM

To investigate a prospective relationship between blood levels of FMN and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection.

METHODS

A total of 146 Chinese hospitalized patients infected with SARS-CoV-2 were consecutively collectively recruited and followed from January 2020 to May 2021. Diagnosis of COVID-19 and SARS-CoV-2 reinfection was based on the diagnostic criteria and treatment protocol in China. The levels of FMN were determined in blood and divided into tertiles based on their distribution in the cohort of COVID-19 patients. Multivariate-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for SARS-CoV-2 reinfection across the tertiles of FMN levels. A Cox regression model was used to generate the HR for SARS-CoV-2 reinfection in the participants in the top tertile of FMN levels compared with those at the bottom. Disease-free survival was used as the time variable, and relapse was used as the state variable, adjusted for age, gender, influencing factors such as diabetes mellitus, hypertension, and corticosteroid therapy, and clinical indexes such as acute liver failure, acute kidney failure, white blood cell (WBC) count, C-reactive protein, prognostic nutritional index (PNI), and blood lipids. Kaplan-Meier analysis with log-rank tests was used to compare the survival rate between patients with elevated FMN levels (FMN > 1.93 mmol/L, the top tertile) and those with nonelevated levels.

RESULTS

Clinical data for the 146 patients with confirmed COVID-19 [age 49 (39-55) years; 49% males] were analyzed. Eleven patients had SARS-CoV-2 reinfection. The SARS-CoV-2 reinfection rate in patients with elevated FMN levels was significantly higher than that in patients with nonelevated FMN (17% vs 3%; P = 0.008) at the end of the 12-mo follow-up. After adjustments for gender, age, diabetes mellitus, hypertension, corticosteroid therapy, WBC count, PNI, indexes of liver and renal function, and blood lipids, patients with nonelevated FMN levels had a lower risk of SARS-CoV-2 reinfection than those with elevated FMN levels (HR = 6.249, 95%CI: 1.377-28.351; P = 0.018). Kaplan-Meier analysis showed that the cumulative survival rate of patients infected with SARS-CoV-2 was higher in patients with nonelevated FMN levels than in those with elevated FMN levels (97% vs 83%; log rank P = 0.002).

CONCLUSION

Elevated levels of FMN are independently associated with SARS-CoV-2 reinfection, which highlights that patients with elevated FMN should be cautiously monitored after hospital discharge.

Keywords: Fructosamine; COVID-19; Reinfection; Blood

Core Tip: Diabetes is a risk factor for coronavirus disease 2019 (COVID-19), which results in increased severity and mortality but has no relationship with reinfection. The present study, for the first time, reported the relationship between severe acute respiratory syndrome coronavirus 2 reinfection and blood levels of fructosamine (FMN), an index reflecting recent glycemic control. Our results demonstrated that FMN levels may influence the prognosis of patients with COVID-19, and patients with high FMN levels should be followed closely to monitor reinfection.