Is Hyperglycemia a Risk Factor Associated with Death in COVID Patients Everywhere in the World? Report from Honduras, Central America

Objective : To determine if hyperglycemia at admission is a risk factor for death in diabetic and non diabetic patients hospitalized for COVID 19 in patients in a third level hospital in Central America.

Methods: Descriptive cross sectional study that included patients hospitalized for  COVID 19 during 2020 in Hospital Escuela, Honduras. We revised information for 1690 patients divided in three categories according to their glycemic values at admission. They were classsified as ˂140 mg/dl category 1, 140-180 mg/dl category 2 and ˃180 mg/dl and category 3; we excluded 352 patients with no recorded glycemic value at admission. 

Results: A total of 1357 patients were included, 644 for category 1 with 240 (37.3%) deaths out of which 58 (24.2%) were known for diabetes and 182 (75.8%) with no previous diabetes diagnosis. In category 2 out of 261 included patients there were 111 (42.5%) deaths with 40(36.0%) and 71(64.0%) previously known and not known for diabetes respectively. In category 3 out of 452 patients 194 (42.9%) deaths were confirmed with 142 (73.2%) in previously known for diabetes and 52 (26.8%) not previously known for diabetes.

Discussion/Conclusion: As reported previously in other parts of the world hyperglycemia proved to be a risk factor associated with death in patients known or not previously for diabetes. Even though it is not the only factor to be taken into consideration it has proven undoubtedly to be something that needs to be addressed upon admission for COVID 19 patients. A basal glucose measurement upon admission is fundamental in every patient and easily accessible even in underprivileged countries like ours. We found an ascending trend in increased mortality as glucose values at admission grow higher; this was true even for patients with no previous diabetes diagnosis.The registered mortality in this group of patients was about 35 to 47% higher compared to normoglycemic patients in the lowest glycemic tertile as has been found in previous publications. In the highest glycemic tertile (category 3) the mortality in diabetic patients found was 73% vrs 26% in non diabetics that presented with extreme hyperglycemia which a also suggests that chronic hyperglycemia is an important determinant.
Hyperglycemia alters pulmonary function due to the non enzimatic glycosilation  of proteins of the lung generating alveolar capillary microangiopathy causing the accumulation of collagen in the extra cellular matrix thus generating restrictive lung disease.