Analysis of Patients Admitted to the Emergency Department With High Blood Glucose Level in the COVID-19 Pandemic Era

Year 2024, Volume: 34 Issue: 5, 591 - 597, 31.10.2024

Zikret Köseoğlu , Deniz Gezer , Seval Müzeyyen Ecin

https://doi.org/10.54005/geneltip.1361996

Abstract

Introduction: This study aims to analyze the relationship and effects of sociodemographic characteristic data and clinical, laboratory and other findings of cases who are admitted to the emergency department (ED) with high blood glucose levels during the COVID-19 pandemic period.
Method: This is a cross-sectional study in which the demographic data, blood gases, blood count and biochemical variables of adult patients admitted to the ED between 01.01.2020 and 31.05.2021 in a 17-month period were retrospectively screened and analyzed.
Results: Infection was detected in 67 (10.5%) of 638 patients with blood glucose level of 300 mg/dl and above. Pneumonia was detected in 56 (8.7%) patients and 203 (31.8%) were hospitalized and 34 (5.3%) died during follow-up. SpO2 was lower (p<0.01), heart rate was higher (p<0.01), systolic blood pressure was lower (p<0.01); in blood gases, pH, HCO3 and CO2 are lower (p<0.01) in the inpatients than outpatients. SpO2 (p<0.01), systolic blood pressure (p<0.01) and diastolic blood pressure (p=0.02) pH (p<0.01) and HCO3 (p<0.01) were lower; WBC (p<0.01), neutrophil (p<0.01) were higher, hemoglobin was lower (p=0.01), platelet (p=0.02) and CRP levels were higher (p<0.01) in patients who died within the follow-up period than the survivors.
Conclusion: Hyperglycemia is a poor prognostic factor in patients hospitalized during the COVID-19 pandemic period. An increase in LDH values, WBC, neutrophils, and a decrease in lymphocyte, hemoglobin and hematocrit values have a negative impact on the outcomes, and clinicians should follow these variables closely.

Keywords

Blood glucose, COVID-19, emergency room, hospitalization, hyperglycemia, mortality

Project Number

NONE

COVID-19 Pandemisi Döneminde Yüksek Kan Şekeri ile Acil Servise Başvuran Hastaların Analizi

Abstract

Giriş: Bu çalışmanın amacı, COVID-19 pandemisi döneminde acil servise kan şekeri yüksekliği ile başvuran olguların sosyodemografik özellikleri ile klinik, laboratuvar ve diğer bulgularının ilişkisini ve etkilerini analiz etmektir.
Yöntem: Bu çalışma, 01.01.2020 ile 31.05.2021 tarihleri arasındaki 17 aylık dönemde acil servise başvuran yetişkin hastaların demografik verileri, kan gazları, kan sayımı ve biyokimyasal değişkenlerinin retrospektif olarak tarandığı ve analiz edildiği kesitsel bir çalışmadır.
Bulgular: Kan glukoz düzeyi 300 mg/dl ve üzerinde olan 638 hastanın 67'sinde (%10,5) enfeksiyon tespit edildi. Hastaların 56'sında (%8,7) pnömoni saptandı ve 203'ü (%31,8) hastaneye yatırıldı ve 34'ü (%5,3) takip sırasında öldü. Takip süresi içinde ölen hastalarda hayatta kalanlara kıyasla; SpO2 (p<0.01), sistolik kan basıncı (p<0.01) ve diastolik kan basıncı (p=0.02), pH (p<0.01) ve HCO3 (p<0.01) daha düşük; WBC (p<0.01), nötrofil (p<0.01) daha yüksek hemoglobin daha düşük (p=0.01), platelet (p=0.02) and CRP seviyesi (p<0.01) daha yüksek saptandı.
Sonuç : Hiperglisemi, COVID-19 pandemisi döneminde hastaneye yatırılan hastalarda kötü prognostik bir faktördür. LDH, WBC, nötrofil değerlerinde artış ve lenfosit, hemoglobin ve hematokrit değerlerinde azalma sonuçları olumsuz etkilemektedir ve klinisyenler bu değişkenleri yakından takip etmelidir.

Keywords

Kan şekeri, COVID-19, Acil Servis, Hastaneye yatış, Hiperglisemi, ölüm

Project Number

NONE

References

• Stojanovic M, Cvetanovic G, Andelkovic- Apostolovic M, et al. Impact of Socio-demographic Characteristics and Long-term Complications on Quality of Life in Patients with Diabetes Mellitus. Central European Journal of Public Health (CEJPH). 2018; 2(2):104–110.
• McCoy RG, Galindo RJ, Swarna KS et al. Sociodemographic, Clinical, and Treatment-Related Factors Associated With Hyperglycemic Crises Among Adults With Type 1 or Type 2 Diabetes in the US From 2014 to 2020. JAMA Network Open. 2021;1:4(9):1-17.
• Guo YW, Wu TE, Chen HS. Prognostic factors of mortality among patients with severe hyperglycemia. The American Journal of Managed Care. 2015;1:21(1):9-22.
• Hartmann-Boyce J, Rees K, Perring JC, et al. Risks of and From SARS-CoV-2 Infection and COVID-19 in People With Diabetes: A Systematic Review of Reviews. Diabetes Care 2021; 44:2790.
• Anthanont P, Khawcharoenporn T, Tharavanij T. Incidences and outcomes of hyperglycemic crises: a 5-year study in a tertiary care center in Thailand. Journal of Medical Association of Thailand. 2012;95(8): 995-1002.
• Capes SE, Hunt D, Malmberg K et al. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet. 2000;355(9206):773-778.
• Terlecki M, Bednarek A, Kawecka-Jaszcz K et al. Acute hyperglycaemia and inflammation in patients with ST segment elevation myocardial infarction. Kardiologia Polska. 2013;71(3):260-267.
• Kitabchi AE, Umpierrez GE, Miles JM et al. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335-1343.
• Jin YH, Cai L, Cheng ZS, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019‐nCoV) infected pneumonia (standard version). Military Medical Research. 2020;7: 4:1-23.
• Van Houten HK, O'Connor PJ, Umpierrez GE et al. Most Frequent Reasons for Emergency Department Visits, 2018. This Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. December, 2021;1-15.
• Alataş ÖD; Gökçek K. Comparison of Patients Applying to the Emergency Service during the Pandemic Period and the Pre-Pandemic Period. Medical Journal of Muğla Sıtkı Koçman University 2021;8(3):195-198.
• Çağatay A. Investigation of Case Mortality Rates in Patients Diagnosed with Covid-19 Admitted to the Emergency Department (Example of a State Hospital in Turkey). Gümüşhane Üniversity Journal of Health Sciences. 2022;11 (1):1-10.
• Hong SI, Kim JS, Kim,YJ, et al. Characteristics of Patients Who Visited Emergency Department: A Nationwide Population-Based Study in South Korea (2016–2018). International Journal of Environmental Research and Public Health. 2022;19(14): 8578:1-13.
• Aslan N, Guner N G, Durmuş E, G et al. Review of Patients who are Hospitalized by Emergency Medicine Specialist. Anatolian Journal of Emergency Medicine. 2021:4(3): 96-101.
• Pepper DJ, Levitt NS, Cleary S, et al. Hyperglycaemic emergency admissions to a secondary-level hospital–an unnecessary financial burden. Journal of Endocrinolohy, Mtabolism and Diabetes of South Africa. 2007;97(10): 963–967.
• Mbugua P K, Otieno CF, Kayima CF, et al. Diabetic ketoacidosis: clinical presentation and precipitating factors at Kenyatta National Hospital, Nairobi. East African Medical Journal. 2005 ;82(12): 191-196.
• Desse Tigestu A, Tesfahun C.E. and Esayas K.G. Predictors and treatment outcome of hyperglycemic emergencies at Jimma University Specialized Hospital, southwest Ethiopia. BioMedCentral (BMC) Research Notes. 2015; 8:553:1-8.
• Ogbera AO, Awobusuyi J, Unachukwu C, et al. Clinical features, predictive factors and outcome of hyperglyaemic emergencies in a developing country. BioMedCentral (BMC) Endocrine Disorders. 2009;9:9:1-5.
• Andrew E. Clinical profile and outcomes of adult patients with hyperglycemic emergencies managed at a tertiary care hospital in Nigeria. Nigerian Medical Journal. 2012;53(3):121–125.
• Basu A, Close CF, Jenkins D,et al. Persisting mortality in diabetic ketoacidosis. Diabetic Medicine 1993;10:282–284.
• MacIsaac RJ, Lee LY, McNeil KJ, et al. Influence of age on the presentation and outcome of acidotic and hyperosmolar diabetic emergencies. Internal Medicine Journal. 2002;32 (8):379-385.
• Cheung NW, Li S, Ma G et al. The relationship between admission blood glucose levels and hospital mortality. Diabetologia, 2008;51(6):952-955.