Fasting Plasma Glucose Increase and Neutrophil-to-Lymphocyte Ratio as Risk Predictors of Clinical Outcome of COVID-19 Pneumonia in Type 2 Diabetes Mellitus

Abstract

Aim of the study To evaluate fasting plasma glucose (FPG) increase and neutrophil-to-lymphocyte ratio (NLR) as risk predictors of severe clinical outcome of COVID-19 pneumonia in type 2 diabetes mellitus (T2DM) hospitalised patients.

Patients and methods Type 2 diabetes mellitus (T2DM) patients hospitalised between March 2020 and February 2021 were studied retrospectively. The NLR ratio at admission and FPG increase (day 7, day with maximal FPG) were evaluated in association with the clinical progression of SARS-CoV-2 infection.

Results Three hundred patients (165 men, 135 women) were included in the study. The mean age was 67.17±8.65 years. Severe COVID-19 pneumonia was diagnosed in 170 patients (56.7%). Fifty-four patients (18%) were intubated and 49 (16.3%) died. Greater increase in FPG (79.5 vs. 44.5 mg/dL for day 1–7, p<0.001; and 113.5 vs. 75 mg/dL for day 1-day with maximum glucose value, p<0.001) and higher NLR at admission (10.65 vs. 6.85) were seen in patients with need of high-flow oxygen compared to those without need, and they were associated with a higher probability of intubation and death.

Conclusion FPG increase and NLR could be significant risk predictors of severe COVID-19 pneumonia in T2DM hospitalised patients.

Key words

SARS-CoV-2 - COVID-19 - diabetes mellitus - hyperglycaemia - NLR

Publication History

Received: 26 July 2022
Received: 22 December 2022

Accepted: 04 January 2023

Accepted Manuscript online:
09 January 2023

Article published online:
16 February 2023

• References

• 1 Wu Z, McGoogan JM.. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323: 1239-1242
• 2 Zhu N, Zhang D, Wang W. et al. China Novel coronavirus investigating and research team a novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382: 727-733
• 3 Zhu L, She ZG, Cheng X. et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab 2020; 31: 1068-1077.e3
• 4 Wang D, Hu B, Hu C. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323: 1061-1069
• 5 Petrakis V, Panagopoulos P, Papazoglou D. et al. Diabetes mellitus and hypertension as major risk factors of mortality from Covid-19 pneumonia. Exp Clin Endocrinol Diabetes 2022; 130: 205-206
• 6 Rao S, Ali K, Dennis J. et al. Analysis of glucose levels in patients hospitalized with COVID-19 during the first phase of this pandemic in West Texas. J Prim Care Community Health. 2020 112150132720958533.
• 7 Hoong CWS, Yeo XE, Lin Y. et al. High glycaemic variability is associated with progression of COVID-19. Acta Diabetol 2021; 58: 1701-1704
• 8 Merzon E, Green I, Shpigelman M. et al. Haemoglobin A1c is a predictor of COVID-19 severity in patients with diabetes. Diabetes Metab Res Rev 2021; 37: e3398
• 9 Alcántara-Alonso E, Molinar-Ramos F, González-López JA. et al. High triglyceride to HDL-cholesterol ratio as a biochemical marker of severe outcomes in COVID-19 patients. Clin Nutr ESPEN 2021; 44: 437-444
• 10 Toori KU, Qureshi MA, Chaudhry A. et al. Neutrophil to lymphocyte ratio (NLR) in COVID-19: A cheap prognostic marker in a resource constraint setting. Pak J Med Sci 2021; 37: 1435-1439
• 11 Serban D, Papanas N, Dascalu AM et al. Significance of neutrophil to lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in diabetic foot ulcer and potential new therapeutic targets. Int J Low Extrem Wounds 2021 Nov 18:15347346211057742. Online ahead of print
• 12 Liang W, Liang H, Ou L. et al. China Medical Treatment Expert Group for COVID-19. Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19. JAMA Intern Med 2020; 180: 1081-1089
• 13 Georgakopoulou VE, Makrodimitri S, Triantafyllou M. et al. Immature granulocytes: Innovative biomarker for SARS‑CoV‑2 infection. Mol Med Rep 2022; 26: 217
• 14 Marshall RJ, Armart P, Hulme KD. et al. Glycemic variability in diabetes increases the severity of influenza. mBio 2020; 11: e02841-19
• 15 Ceriello A, Esposito K, Piconi L. et al. Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes 2008; 57: 1349-1354
• 16 Chao W-C, Tseng C-H, Wu C-L. et al. Higher glycemic variability within the first day of ICU admission is associated with increased 30-day mortality in ICU patients with sepsis. Ann Intensive Care 2020; 10: 17
• 17 Toori KU, Qureshi MA, Chaudhry A. et al. Neutrophil to lymphocyte ratio (NLR) in COVID-19: A cheap prognostic marker in a resource constraint setting. Pak J Med Sci 2021; 37: 1435-1439
• 18 Yang AP, Liu JP, Tao WQ. et al. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol 2020; 84: 106504
• 19 Chan AS, Rout A.. Use of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in COVID-19. J Clin Med Res 2020; 12: 448-453
• 20 Hussain M, Babar MZM, Akhtar L. et al. Neutrophil lymphocyte ratio (NLR): A well assessment tool of glycemic control in type 2 diabetic patients. Pak J Med Sci 2017; 33: 1366-1370
• 21 Petrakis V, Trypsianis G, Panagopoulos P. et al. Diabetes mellitus as the major factor of prolonged hospitalisation in mild or moderate COVID-19 pneumonia. Exp Clin Endocrinol Diabetes 2022; 130: 351-352
• 22 Petrakis V, Panagopoulos P, Trypsianis G et al. Glucose on admission: Unfavourable effects on hospitalisation and outcomes in type 2 diabetes mellitus patients with COVID-19 pneumonia. Exp Clin Endocrinol Diabetes 2021 Nov 29. Online ahead of print