Diabetes/hyperglycemia is associated with thromboembolic complications in COVID-19.
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Venous thrombosis events are the most affected by the presence of diabetes/hyperglycemia.
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Thromboembolism increases the risk for an adverse clinical outcome only in diabetes/hyperglycemia.
Abstract
Purpose
Individuals with diabetes/stress hyperglycemia carry an increased risk for adverse clinical outcome in case of SARS-CoV-2 infection. The purpose of this study was to evaluate whether this risk is, at least in part, modulated by an increase of thromboembolic complications.
Methods
We prospectively followed 180 hospitalized patients with confirmed COVID-19 pneumonia admitted to the Internal Medicine Units of San Raffaele Hospital. Data from 11 out of 180 patients were considered incomplete and excluded from the analysis. We analysed inflammation, tissue damage biomarkers, hemostatic parameters, thrombotic events (TEs) and clinical outcome according to the presence of diabetes/stress hyperglycemia.
Results
Among 169 patients, 51 (30.2%) had diabetes/stress hyperglycemia. Diabetes/stress hyperglycemia and fasting blood glucose (FBG) were associated with increased inflammation and tissue damage circulating markers, higher D-dimer levels, increased prothrombin time and lower antithrombin III activity. Forty-eight venous and 10 arterial TEs were identified in 49 (29%) patients. Diabetes/stress hyperglycemia (HR 2.71, p = 0.001), fasting blood glucose (HR 4.32, p < 0.001) and glucose variability (HR 1.6, p < 0.009) were all associated with an increased risk of thromboembolic complication. TEs significantly increased the risk for an adverse clinical outcome only in the presence of diabetes/stress hyperglycemia (HR 3.05, p = 0.010) or fasting blood glucose ≥7 mmol/L (HR 3.07, p = 0.015).
Conclusions
Thromboembolism risk is higher among patients with diabetes/stress hyperglycemia and COVID-19 pneumonia and is associated to poor clinical outcome. In case of SARS-Cov-2 infection patients with diabetes/stress hyperglycemia could be considered for a more intensive prophylactic anticoagulation regimen.
Abbreviation
aD-dimer
age-specific high D-dimer
ALT
alanine aminotransferase
AST
Aspartate transaminase
CRP
C-reactive protein
DIC
disseminated intravascular coagulation
DOACs
direct oral anticoagulants
DVT
deep vein thrombosis
FBG
fasting blood glucose
ICU
Intensive Care Unit
IQR
inter-quartile range
ISTH
International Society on Thrombosis and Hemostasis