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Some characteristics of hyperglycaemic crisis differ between patients with and without COVID-19 at a safety-net hospital in a cross-sectional study.
Shah, Arnav; Deak, Andrew; Allen, Shaneisha; Silfani, Elayna; Koppin, Christina; Zisman-Ilani, Yaara; Sirisena, Imali; Rose, Christina; Rubin, Daniel.
Afiliação
  • Shah A; Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
  • Deak A; Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
  • Allen S; Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
  • Silfani E; School of Pharmacy, Temple University, Philadelphia, PA, USA.
  • Koppin C; Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
  • Zisman-Ilani Y; Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA.
  • Sirisena I; Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
  • Rose C; School of Pharmacy, Temple University, Philadelphia, PA, USA.
  • Rubin D; Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Ann Med ; 53(1): 1642-1645, 2021 12.
Article em En | MEDLINE | ID: mdl-34511013
ABSTRACT

OBJECTIVE:

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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cetoacidose Diabética / COVID-19 / Coma Hiperglicêmico Hiperosmolar não Cetótico Tipo de estudo: Observational_studies / Prevalence_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cetoacidose Diabética / COVID-19 / Coma Hiperglicêmico Hiperosmolar não Cetótico Tipo de estudo: Observational_studies / Prevalence_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2021 Tipo de documento: Article