Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2023; 11(6): 1287-1298
Published online Feb 26, 2023. doi: 10.12998/wjcc.v11.i6.1287
Hyperglycemia in COVID-19 infection without diabetes mellitus: Association with inflammatory markers
Harinivaas Shanmugavel Geetha, Garima Singh, Abinesh Sekar, Maya Gogtay, Yuvaraj Singh, George M Abraham, Nitin Trivedi
Harinivaas Shanmugavel Geetha, Garima Singh, Abinesh Sekar, Yuvaraj Singh, George M Abraham, Nitin Trivedi, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
Maya Gogtay, Department of Hospice and Palliative Medicine, University of Texas Health, San Antonio, TX 78229, United States
George M Abraham, Department of Internal Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
Author contributions: Geetha HS and Trivedi N conceived the idea for the study; Geetha HS, Gogtay M, Abraham GM, and Trivedi N designed and undertook the literature review; Geetha HS, Singh G, Sekar A, and Gogtay M collected data; Gogtay M and Singh Y performed the statistical analysis, figures, and appendix and analyzed and interpreted the data; Geetha HS, Singh G, Sekar A, Singh Y and Gogtay M wrote the first draft of the manuscript; Geetha HS, Singh G, Sekar A, Gogtay M, Singh Y, Abraham GM, Trivedi N revised the subsequent drafts of the manuscript; All authors reviewed and agreed on the final draft of the manuscript.
Institutional review board statement: The study was reviewed and approved by our local Medical Center Institutional Review Board (Approval No. 2020-035).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data is available.
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: Yuvaraj Singh, MD, Chief Medical Resident, Researcher, Department of Internal Medicine, Saint Vincent Hospital, No. 123 Summer Street, Worcester, MA 01608, United States. yuvarajmle@gmail.com
Received: October 30, 2022
Peer-review started: October 30, 2022
First decision: November 27, 2022
Revised: December 17, 2022
Accepted: February 3, 2023
Article in press: February 3, 2023
Published online: February 26, 2023
Processing time: 117 Days and 3.4 Hours
ARTICLE HIGHLIGHTS
Research background

New onset hyperglycemia is common in patients with severe coronavirus disease 2019 (COVID-19) infection. Cytokine storm and direct severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced pancreatic β-cell failure have been postulated to play a role in new-onset hyperglycemia.

Research motivation

Based on evidence regarding the "Immune-mediated inflammatory storm" during the COVID-19 illness. It has also been proposed that COVID-19 is likely associated with an increased risk of developing diabetes. This motivated us to study the underlying mechanisms contributing to new onset hyperglycemia in hospitalized COVID-19 cases.

Research objectives

To assess the validity of the cytokine-induced hyperglycemia hypothesis by evaluating the association between inflammatory markers and new onset hyperglycemia in non-diabetic patients with COIVD-19 infection.

Research methods

A retrospective case-control study was conducted on adults without diabetes mellitus hospitalized for COVID-19 infection. The serum levels of glucose and inflammatory markers at presentation before initiation of corticosteroid were collected. Hyperglycemia was defined as glucose levels ≥ 140 mg/dL. Prespecified cutoffs were used for the inflammatory markers. Statistical methods of analysis were used to calculate the logistic regression for hyperglycemia.

Research results

Of the 520 patients screened, 248 met the inclusion criteria. Our study showed no association between C-reactive protein, ferritin, Lactate dehydrogenase, D-dimer levels, and new-onset hyperglycemia in non-diabetic patients with COVID-19 infection. We observed significantly higher mortality and length of stay in patients with hyperglycemia.

Research conclusions

With new-onset hyperglycemia being closely associated with poor prognostic indices, it becomes pivotal to understand the underlying pathophysiological mechanisms behind the SARS-CoV-2 infection-induced hyperglycemia. This will help us better control the glycemic status and prevent new-onset hyperglycemia, thereby improving the clinical recovery of patients. Our study results indicate the low probability of the stress hyperglycemia hypothesis being the sole mechanism of SARS-CoV-2 infection-induced hyperglycemia but rather a multicausal pathogenesis leading to hyperglycemia that requires further research and understanding.

Research perspectives

Basic science research that would help better understand the underlying pathophysiology and further clinical studies that assess the utility of different treatment strategies in managing hyperglycemia are required to improve the clinical outcomes of COVID-19.