LitCovid-sentences  

PMC:7347402 / 2187-30720 JSONTXT 13 Projects

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Id Subject Object Predicate Lexical cue
T18 0-12 Sentence denotes Introduction
T19 13-198 Sentence denotes Since December 2019, a pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), dubbed coronavirus disease 2019 (COVID-19) hit Wuhan, Hubei province, China [1].
T20 199-335 Sentence denotes As the infection quickly spread around the globe to an alarming level, the WHO unprecedentedly declared a pandemic on 11 March 2020 [2].
T21 336-486 Sentence denotes As of 6 June 2020, the number of affected countries and regions has soared to 216, with more than 6,600,000 cases of COVID-19 confirmed worldwide [3].
T22 487-563 Sentence denotes A total of 392,000 patients have died of COVID-19, according to the WHO [3].
T23 564-809 Sentence denotes The crude fatality ratio (CFR) stood at 5.9% as of 6 June 2020 [3], whereas, at the inception of the outbreak, the overall CFR was 17.3%, as reported by the WHO–China joint mission [1], and even moderately ill patients may progress to death [1].
T24 810-912 Sentence denotes Therefore, it is crucial to assess the prognosis of the illness early and start intervention promptly.
T25 913-1203 Sentence denotes As we know, diabetes is an established risk factor for significantly elevated mortality rates in a wide array of acute or chronic diseases, such as cardiovascular diseases, cerebrovascular diseases, cancer and infections due to poor glycaemic control and chronic hyperglycaemic state [4–7].
T26 1204-1342 Sentence denotes In addition, one study showed that fasting hyperglycaemia was strongly correlated with mortality in patients with or without diabetes [7].
T27 1343-1554 Sentence denotes Evidence indicated that a chronic hyperglycaemic state was associated with impaired immunity [6] and hyperglycaemia is an independent predictor for lower respiratory tract infection and poor prognosis [6, 8–10].
T28 1555-1775 Sentence denotes In particular, a few previous studies have shown that hyperglycaemia was a risk factor for high morbidity and mortality from severe acute respiratory syndrome (SARS) [11] and Middle East respiratory syndrome (MERS) [12].
T29 1776-2051 Sentence denotes Recently, a descriptive study suggested that diabetes and/or acute uncontrolled hyperglycaemia (defined as blood glucose measurements >10 mmol/l twice within any 24 h period) were associated with an increased length of hospital stay and higher mortality due to COVID-19 [13].
T30 2052-2409 Sentence denotes Furthermore, well-controlled blood glucose (glycaemic variability within 3.9–10.0 mmol/l) was reportedly associated with markedly lower mortality compared with individuals with poorly controlled blood glucose (upper limit of glycaemic variability exceeding 10.0 mmol/l) in patients with pre-existing type 2 diabetes during hospitalisation for COVID-19 [14].
T31 2410-2593 Sentence denotes However, direct correlation between fasting blood glucose (FBG) level at admission and clinical outcomes of COVID-19 patients without diagnosed diabetes has not been well established.
T32 2594-2774 Sentence denotes Therefore, in this study, we examined the association between FBG on admission and the 28-day mortality of COVID-19 patients without previously diagnosed diabetes in two hospitals.
T33 2776-2783 Sentence denotes Methods
T34 2785-2814 Sentence denotes Study design and participants
T35 2815-3080 Sentence denotes We conducted a retrospective study of COVID-19 patients admitted to Wuhan Union West Hospital and Wuhan Red Cross Hospital to ascertain whether FBG was an independent predictor for 28-day mortality in patients with COVID-19 without a previous diagnosis of diabetes.
T36 3081-3192 Sentence denotes COVID-19 infection was laboratory-confirmed in accordance with the interim guidance formulated by the WHO [15].
T37 3193-3312 Sentence denotes The aforementioned hospitals were two mandatorily designated hospitals for the treatment of COVID-19 patients in China.
T38 3313-3377 Sentence denotes The institutional ethics committees of Wuhan Union Hospital (No.
T39 3378-3426 Sentence denotes 0036) reviewed and approved this study protocol.
T40 3427-3536 Sentence denotes No patients or medical staff involved in patient care took part in the study design and statistical analyses.
T41 3537-3738 Sentence denotes All consecutive patients included in this study had a definitive outcome (died, discharged or still hospitalised) within 28 days, with the time period spanning from 24 January 2020 to 10 February 2020.
T42 3739-4268 Sentence denotes All patients received standard treatment, including antiviral therapy, respiratory support (nasal cannulation, mask oxygenation, high-flow nasal cannula oxygen therapy, non-invasive positive pressure ventilation or invasive mechanical ventilation), symptomatic and supportive treatment and antimicrobial therapy, as appropriate, to prevent or treat secondary infections, which was in accordance with the COVID-19 diagnosis and treatment protocols released by the National Health Commission of the People’s Republic of China [16].
T43 4269-4352 Sentence denotes This retrospective project did not interfere with the course of medical management.
T44 4353-4434 Sentence denotes A total of 1258 confirmed COVID-19 patients were admitted into the two hospitals.
T45 4435-5109 Sentence denotes Of these, 653 patients were ruled out for one of the following reasons: (1) no definitive 28-day outcome since they were transferred to another hospital; (2) missing key clinical information (e.g. demographic or clinical data); (3) no FBG data available at admission (for one of the following reasons: [a] patients had a blood glucose measurement taken before admission; [b] patients were tested for blood glucose 24 h after admission; [c] patients received a random blood glucose test but were not tested for FBG; [d] patients did not receive a blood glucose test since this was not routinely conducted for every COVID-19 patient); (4) having previously diagnosed diabetes.
T46 5110-5170 Sentence denotes The flow diagram of patient selection is detailed in Fig. 1.
T47 5171-5258 Sentence denotes Fig. 1 Flow diagram of patient selection. aReasons for no FBG measurement at admission:
T48 5259-5587 Sentence denotes 13 patients had a blood glucose measurement taken before admission; 25 patients were tested for blood glucose 24 h after admission; 84 patients received a random blood glucose test but were not tested for FBG; and 81 patients did not receive a blood glucose test since this was not routinely conducted for every COVID-19 patient
T49 5588-6037 Sentence denotes Patients were discharged when they met the following discharge criteria: (1) body temperature returned to normal, lasting for more than 3 days; (2) respiratory symptoms significantly improved; (3) imaging examinations revealed that acute exudative lesions were significantly improved; (4) two real-time RT-PCR tests for the presence of SARS-CoV-2 virus yielded negative results (with two samples of respiratory specimens taken over 24 h apart) [16].
T50 6039-6054 Sentence denotes Data collection
T51 6055-6128 Sentence denotes We obtained data from the electronic records of the relevant departments.
T52 6129-6302 Sentence denotes The following data were collected: demographics, clinical data (symptoms, past medical history, admission FBG and in-hospital complications) and the data on 28-day outcomes.
T53 6303-6603 Sentence denotes Past medical histories were obtained from hospital databases or by self-reporting, including diabetes, hypertension, chronic lung disease, chronic heart disease, chronic liver disease, chronic kidney disease, cerebrovascular disease and carcinoma, which were diagnosed according to standard criteria.
T54 6604-6845 Sentence denotes The common complications that developed after hospitalisation included acute respiratory distress syndrome (ARDS), acute cardiac injury, acute kidney injury, acute liver injury, cerebrovascular accident, coagulopathy and secondary infection.
T55 6847-6900 Sentence denotes Definition and measurement of FBG levels at admission
T56 6901-7021 Sentence denotes Complications were defined as the occurrence of one or more condition(s) (Table 1) that developed after hospitalisation.
T57 7022-7098 Sentence denotes ARDS was defined according to WHO clinical management interim guidance [17].
T58 7099-7357 Sentence denotes Acute cardiac injury was defined as new electrocardiographic and echocardiographic abnormalities detected, or serum level of cardiac biomarkers (cardiac troponin I, cardiac troponin T, or hype-sensitive troponin I) above the upper limit of normal (ULN) [18].
T59 7358-7558 Sentence denotes Acute kidney injury was defined as an elevation of serum creatinine by 26.5 μmol/l or higher within 48 h, or serum creatinine increased to 1.5 times baseline or higher within the previous 7 days [19].
T60 7559-7679 Sentence denotes Acute liver injury was defined as alanine aminotransferase or aspartate aminotransferase levels two times above the ULN.
T61 7680-7810 Sentence denotes Cerebrovascular accident was defined as the occurrence of cerebral haemorrhage or cerebral infarction during hospitalisation [20].
T62 7811-7936 Sentence denotes Coagulopathy was defined as prothrombin time prolonged by 3 s or activated partial thromboplastin time prolonged by 5 s [21].
T63 7937-8145 Sentence denotes Secondary infection was defined as the occurrence of symptoms or signs of nosocomial infection and new pathogens detected in patients’ specimens (e.g. sputum, blood) taken more than 48 h after admission [18].
T64 8146-8269 Sentence denotes Table 1 Baseline characteristics of COVID-19 patients without previous diagnosis of diabetes within 28 days after admission
T65 8270-8342 Sentence denotes Variables Total(n = 605) Non-survivor(n = 114) Survivor(n = 491) p value
T66 8343-8351 Sentence denotes Hospital
T67 8352-8416 Sentence denotes  Wuhan Red Cross Hospital 157 (26.0) 33 (21.0) 124 (79.0) 0.4178
T68 8417-8475 Sentence denotes  Wuhan Union West Hospital 448 (74.0) 81 (18.1) 367 (81.9)
T69 8476-8486 Sentence denotes Age, years
T70 8487-8562 Sentence denotes  Median (IQR) 59.0 (47.0, 68.0) 66.0 (61.0, 72.0) 56.0 (43.0, 65.0) <0.0001
T71 8563-8614 Sentence denotes  <65, n (%) 408 (67.4) 49 (43.0) 359 (73.1) <0.0001
T72 8615-8658 Sentence denotes  ≥65, n (%) 197 (32.6) 65 (57.0) 132 (26.9)
T73 8659-8662 Sentence denotes Sex
T74 8663-8716 Sentence denotes  Female, n (%) 283 (46.8) 36 (31.6) 247 (50.3) 0.0003
T75 8717-8761 Sentence denotes  Male, n (%) 322 (53.2) 78 (68.4) 244 (49.7)
T76 8762-8776 Sentence denotes Onset symptoms
T77 8777-8833 Sentence denotes  Fever, n (%) 463/530 (87.4) 88 (85.4) 375 (87.8) 0.5132
T78 8834-8890 Sentence denotes  Cough, n (%) 404/555 (72.8) 66 (66.7) 338 (74.1) 0.1308
T79 8891-8955 Sentence denotes  Expectoration, n (%) 217/521 (41.7) 43 (43.4) 174 (41.2) 0.6892
T80 8956-9024 Sentence denotes  Muscular soreness, n (%) 129/504 (25.6) 23 (24.5) 106 (25.9) 0.7813
T81 9025-9083 Sentence denotes  Fatigue, n (%) 300/528 (56.8) 58 (58.6) 242 (56.4) 0.6936
T82 9084-9142 Sentence denotes  Diarrhoea, n (%) 91/512 (17.8) 15 (15.3) 76 (18.4) 0.4774
T83 9143-9205 Sentence denotes Past history of disease 208 (34.4) 55 (48.3) 153 (31.2) 0.0005
T84 9206-9269 Sentence denotes  Hypertension, n (%) 139/543 (25.6) 34 (29.8) 105 (24.5) 0.2447
T85 9270-9331 Sentence denotes  Chronic lung disease, n (%) 18 (3.0) 4 (3.5) 14 (2.9) 0.7587
T86 9332-9396 Sentence denotes  Chronic heart disease, n (%) 55 (9.1) 13 (11.4) 42 (8.6) 0.3404
T87 9397-9460 Sentence denotes  Chronic liver disease, n (%) 16 (2.6) 3 (2.6) 13 (2.7) >0.9999
T88 9461-9524 Sentence denotes  Chronic kidney disease, n (%) 16 (2.6) 6 (5.3) 10 (2.0) 0.0531
T89 9525-9588 Sentence denotes  Cerebrovascular disease, n (%) 16 (2.6) 7 (6.1) 9 (1.8) 0.0098
T90 9589-9639 Sentence denotes  Carcinoma, n (%) 29 (4.8) 9 (7.9) 20 (4.1) 0.0853
T91 9640-9660 Sentence denotes CRB-65 score <0.0001
T92 9661-9702 Sentence denotes  0, n (%) 334 (55.2) 27 (23.7) 307 (62.5)
T93 9703-9746 Sentence denotes  1–2, n (%) 261 (43.1) 80 (70.2) 181 (36.9)
T94 9747-9783 Sentence denotes  3–4, n (%) 10 (1.7) 7 (6.1) 3 (0.6)
T95 9784-9805 Sentence denotes Admission FBG <0.0001
T96 9806-9857 Sentence denotes  <6.1 mmol/l, n (%) 329 (54.4) 35 (30.7) 294 (59.9)
T97 9858-9911 Sentence denotes  6.1–6.9 mmol/l, n (%) 100 (16.5) 21 (18.4) 79 (16.1)
T98 9912-9963 Sentence denotes  ≥7.0 mmol/l, n (%) 176 (29.1) 58 (50.9) 118 (24.0)
T99 9964-10019 Sentence denotes Complications 237 (39.2) 114 (100.0) 123 (25.1) <0.0001
T100 10020-10071 Sentence denotes  ARDS, n (%) 142 (23.5) 107 (93.9) 35 (7.1) <0.0001
T101 10072-10137 Sentence denotes  Acute cardiac injury, n (%) 80 (13.2) 63 (55.3) 17 (3.5) <0.0001
T102 10138-10202 Sentence denotes  Acute kidney injury, n (%) 76 (12.6) 65 (57.0) 11 (2.2) <0.0001
T103 10203-10268 Sentence denotes  Acute liver injury, n (%) 167 (27.6) 95 (83.3) 72 (14.7) <0.0001
T104 10269-10326 Sentence denotes  Cerebrovascular accident, n (%) 3 (0.5) 3 (2.6) 0 0.0065
T105 10327-10384 Sentence denotes  Coagulopathy, n (%) 96 (15.9) 85 (74.6) 11 (2.2) <0.0001
T106 10385-10449 Sentence denotes  Secondary infection, n (%) 79 (13.1) 69 (60.5) 10 (2.0) <0.0001
T107 10450-10468 Sentence denotes With complications
T108 10469-10518 Sentence denotes  <6.1 mmol/l, n (%) 86 (14.2) 35 (30.7) 51 (10.4)
T109 10519-10569 Sentence denotes  6.1–6.9 mmol/l, n (%) 48 (7.9) 21 (18.4) 27 (5.5)
T110 10570-10619 Sentence denotes  ≥7.0 mmol/l, n (%) 103 (17.0) 58 (50.9) 45 (9.2)
T111 10620-10641 Sentence denotes Without complications
T112 10642-10685 Sentence denotes  <6.1 mmol/l, n (%) 243 (40.2) 0 243 (49.5)
T113 10686-10729 Sentence denotes  6.1–6.9 mmol/l, n (%) 52 (8.6) 0 52 (10.6)
T114 10730-10771 Sentence denotes  ≥7.0 mmol/l, n (%) 73 (12.1) 0 73 (14.9)
T115 10772-10802 Sentence denotes Data are median (IQR) or n (%)
T116 10803-10940 Sentence denotes p values were calculated by using χ2 test, Cochran–Mantel–Haenszel χ2 test, Fisher’s exact test or Wilcoxon rank-sum test, as appropriate
T117 10941-11184 Sentence denotes Seventy-five patients (12.4%) had missing information on onset symptoms of fever; 50 (8.3%) on cough; 84 (13.9%) on expectoration; 101 (16.7%) on muscular soreness; 77 (12.7%) on fatigue; 93 (15.4%) on diarrhoea; and 62 (10.2%) on hypertension
T118 11185-11361 Sentence denotes For the test of FBG levels at admission, blood samples were collected after an overnight fast lasting at least 8 h within 24 h after admission, according to the WHO guidelines.
T119 11362-11486 Sentence denotes Serum concentrations of FBG were measured by using an automatic biochemical analyser (Beckman Coulter AU5800 Analyzer, USA).
T120 11488-11520 Sentence denotes Assessment of pneumonia severity
T121 11521-11646 Sentence denotes CRB-65 is a generally accepted tool used for assessing the severity of pneumonia because of its simplicity and effectiveness.
T122 11647-11805 Sentence denotes It is based on confusion, respiratory rate (>30/min), systolic blood pressure (≤90 mmHg) or diastolic blood pressure (≤60 mmHg), and age (≥65 years) [22, 23].
T123 11806-12061 Sentence denotes Given that pneumonia is the major clinical feature of hospitalised COVID-19 patients [24], and all participants enrolled had pneumonia, as confirmed by chest computed tomography (CT) scans, CRB-65 was used in this study to assess the severity of COVID-19.
T124 12062-12280 Sentence denotes CRB-65 measures the severity of pneumonia on a 0 to 4 scale, and we grouped scores into three risk levels (CRB-65 score of 0; CRB-65 score of 1–2; CRB-65 score of 3–4) according to Ewig et al [23] and Lepper et al [9].
T125 12281-12382 Sentence denotes CRB-65 score 0, 1–2 and 3–4 are, respectively, representative of mild, moderate and severe pneumonia.
T126 12384-12400 Sentence denotes Outcome measures
T127 12401-12536 Sentence denotes All patients were categorised into three groups according to WHO guidelines in terms of admission FBG (<6.1, 6.1–6.9, and ≥7.0 mmol/l).
T128 12537-12708 Sentence denotes Two outcome measures were examined: the independent risk factors for 28-day mortality and percentage differences in in-hospital complications between different FBG groups.
T129 12710-12730 Sentence denotes Statistical analysis
T130 12731-12798 Sentence denotes Descriptive statistics were used to describe patient baseline data.
T131 12799-12999 Sentence denotes Categorical variables were presented as numbers with percentage proportions, and continuous variables were expressed as mean ± SD if they were normally distributed or as median (IQR) if they were not.
T132 13000-13126 Sentence denotes Proportions for categorical variables were compared using the χ2 test, Cochran–Mantel–Haenszel χ2 test or Fisher’s exact test.
T133 13127-13242 Sentence denotes Means of continuous variables were compared using independent group t test when the data were normally distributed.
T134 13243-13302 Sentence denotes Otherwise, the Wilcoxon rank-sum test was used for medians.
T135 13303-13514 Sentence denotes For the analysis of mortality, we conducted a univariable Cox regression analysis to assess the effects of age, sex, onset symptoms, past medical history, CRB-65 score, and admission FBG on the 28-day mortality.
T136 13515-13756 Sentence denotes Variables with p < 0.05 were regarded as potential risk factors and were included in multivariable Cox regression analysis by using the stepwise bidirectional selection (significance level for entry = 0.05, significance level to stay = 0.1).
T137 13757-13980 Sentence denotes We conducted subgroup analysis by using Kaplan–Meier curves to assess associations between FBG or severity of pneumonia and mortality within 28 days, and tested linear trends across different groups of different FBG levels.
T138 13981-14123 Sentence denotes Then we carried out a test for interaction of FBG levels and severity of pneumonia and stratified analyses according to severity of pneumonia.
T139 14124-14257 Sentence denotes Finally, univariable logistic analysis was used to assess the association between different FBG levels and in-hospital complications.
T140 14258-14331 Sentence denotes A two-sided p value <0.05 was considered to be statistically significant.
T141 14332-14410 Sentence denotes All statistical analyses were performed using SAS software (version 9.4; USA).
T142 14412-14419 Sentence denotes Results
T143 14421-14444 Sentence denotes Patient characteristics
T144 14445-14577 Sentence denotes Up to 10 February 2020, 1258 patients were admitted to Wuhan Union West Hospital or Wuhan Red Cross Hospital for confirmed COVID-19.
T145 14578-14964 Sentence denotes After excluding 157 patients who were re-directed to other hospitals, 182 patients missing key clinical information, 203 patients without FBG at admission and 111 patients with previous history of diabetes, a total of 605 patients without a previous diagnosis of diabetes (448 from Wuhan Union West Hospital and 157 from Wuhan Red Cross Hospital) were included in the analysis (Fig. 1).
T146 14965-15088 Sentence denotes Baseline data of continuous and categorical variables among the groups of survivors and non-survivors are shown in Table 1.
T147 15089-15178 Sentence denotes The median age of participants was 59.0 years (IQR 47.0, 68.0), and 322 (53.2%) were men.
T148 15179-15303 Sentence denotes Two hundred and eight patients (34.4%) had one or more past diseases, of which hypertension was the most common comorbidity.
T149 15304-15385 Sentence denotes At admission, the most common symptoms were fever, followed by cough and fatigue.
T150 15386-15533 Sentence denotes Three hundred and thirty four patients (55.2%) had a CRB-65 score of 0; 261 (43.1%) had a CRB-65 score of 1–2; 10 (1.7%) had a CRB-65 score of 3–4.
T151 15534-15765 Sentence denotes The patients were categorised in terms of their glucose levels into three groups: patients with FBG <6.1 mmol/l (n = 329, 54.4%), patients with FBG 6.1–6.9 mmol/l (n = 100, 16.5%) and patients with FBG ≥7.0 mmol/l (n = 176, 29.1%).
T152 15766-15851 Sentence denotes One hundred and fourteen patients (18.8%) died within 28 days during hospitalisation.
T153 15852-15942 Sentence denotes Among 605 patients, 237 (39.2%) developed one or more in-hospital complications (Table 1).
T154 15944-15990 Sentence denotes Comparison between non-survivors and survivors
T155 15991-16217 Sentence denotes Compared with survivors, more non-survivors were found among older people (median age 66.0 years vs 56.0 years, p < 0.0001), male (68.4% vs 49.7%, p = 0.0003), patients with a past medical history (48.3% vs 31.2%, p = 0.0005).
T156 16218-16363 Sentence denotes In terms of past medical history, cerebrovascular disease (6.1% vs 1.8%, p = 0.0098) was significantly higher in non-survivors than in survivors.
T157 16364-16492 Sentence denotes In non-survivors, the percentages were higher in patients having CRB-65 score of 3–4 and FBG ≥7.0 mmol/l at admission (Table 1).
T158 16494-16546 Sentence denotes Factors associated with in-hospital 28-day mortality
T159 16547-16734 Sentence denotes The univariable Cox regression analysis showed that age, male sex, chronic kidney disease, cerebrovascular disease, CRB-65 score and FBG were associated with in-hospital 28-day mortality.
T160 16735-17073 Sentence denotes The multivariable Cox regression analysis further suggested that age (HR 1.02 [95% CI 1.00, 1.04]), male sex (HR 1.75 [95% CI 1.17, 2.60]), CRB-65 score 1–2 (HR 2.68 [95% CI 1.56, 4.59]), CRB-65 score 3–4 (HR 5.25 [95% CI 2.05, 13.43]) and FBG ≥7.0 mmol/l (HR 2.30 [95% CI 1.49, 3.55]) were independent predictors for mortality (Table 2).
T161 17074-17187 Sentence denotes Table 2 Univariable and multivariable analyses of various indicators for death within 28 days in all participants
T162 17188-17271 Sentence denotes Univariable analysis HR (95% CI) p value Multivariable analysis HR (95% CI) p value
T163 17272-17280 Sentence denotes Hospital
T164 17281-17314 Sentence denotes  Wuhan Red Cross Hospital 1 (ref)
T165 17315-17366 Sentence denotes  Wuhan Union West Hospital 0.85 (0.57, 1.28) 0.4347
T166 17367-17428 Sentence denotes Age, years 1.05 (1.03, 1.06) <0.0001 1.02 (1.00, 1.04) 0.0252
T167 17429-17455 Sentence denotes Sex Female 1 (ref) 1 (ref)
T168 17456-17510 Sentence denotes Male 2.03 (1.37, 3.01) 0.0004 1.75 (1.17, 2.60) 0.0060
T169 17511-17525 Sentence denotes Onset symptoms
T170 17526-17543 Sentence denotes  Fever No 1 (ref)
T171 17544-17572 Sentence denotes Yes 0.84 (0.48, 1.44) 0.5191
T172 17573-17590 Sentence denotes  Cough No 1 (ref)
T173 17591-17619 Sentence denotes Yes 0.71 (0.47, 1.08) 0.1125
T174 17620-17645 Sentence denotes  Expectoration No 1 (ref)
T175 17646-17674 Sentence denotes Yes 1.06 (0.71, 1.58) 0.7788
T176 17675-17704 Sentence denotes  Muscular soreness No 1 (ref)
T177 17705-17733 Sentence denotes Yes 0.92 (0.57, 1.47) 0.7256
T178 17734-17753 Sentence denotes  Fatigue No 1 (ref)
T179 17754-17782 Sentence denotes Yes 1.07 (0.72, 1.60) 0.7386
T180 17783-17804 Sentence denotes  Diarrhoea No 1 (ref)
T181 17805-17833 Sentence denotes Yes 0.83 (0.48, 1.44) 0.5124
T182 17834-17857 Sentence denotes Past history of disease
T183 17858-17887 Sentence denotes  Hypertension Without 1 (ref)
T184 17888-17917 Sentence denotes With 1.27 (0.85, 1.89) 0.2493
T185 17918-17955 Sentence denotes  Chronic lung disease Without 1 (ref)
T186 17956-17985 Sentence denotes With 1.12 (0.41, 3.03) 0.8285
T187 17986-18024 Sentence denotes  Chronic heart disease Without 1 (ref)
T188 18025-18054 Sentence denotes With 1.34 (0.75, 2.39) 0.3151
T189 18055-18093 Sentence denotes  Chronic liver disease Without 1 (ref)
T190 18094-18123 Sentence denotes With 0.95 (0.30, 2.99) 0.9296
T191 18124-18163 Sentence denotes  Chronic kidney disease Without 1 (ref)
T192 18164-18193 Sentence denotes With 2.28 (1.00, 5.19) 0.0496
T193 18194-18234 Sentence denotes  Cerebrovascular disease Without 1 (ref)
T194 18235-18264 Sentence denotes With 2.82 (1.31, 6.05) 0.0080
T195 18265-18291 Sentence denotes  Carcinoma Without 1 (ref)
T196 18292-18321 Sentence denotes With 1.81 (0.92, 3.58) 0.0876
T197 18322-18352 Sentence denotes CRB-65 score 0 1 (ref) 1 (ref)
T198 18353-18406 Sentence denotes 1–2 4.35 (2.81, 6.72) <0.0001 2.68 (1.56–4.59) 0.0003
T199 18407-18463 Sentence denotes 3–4 13.80 (5.99, 31.80) <0.0001 5.25 (2.05–13.43) 0.0005
T200 18464-18506 Sentence denotes Admission FBG, mmol/l <6.1 1 (ref) 1 (ref)
T201 18507-18564 Sentence denotes 6.1–6.9 2.06 (1.20, 3.54) 0.0087 1.71 (0.99, 2.94) 0.0524
T202 18565-18620 Sentence denotes ≥7.0 3.54 (2.33, 5.38) <0.0001 2.30 (1.49, 3.55) 0.0002
T203 18621-18824 Sentence denotes The cumulative death rate within 28 days in all COVID-19 participants stratified in terms of FBG and CRB-65 score at admission overall is shown in Fig. 2a (ptrend < 0.0001) and Fig. 2b (ptrend = 0.0020).
T204 18825-19054 Sentence denotes Compared with patients with FBG <6.1 mmol/l, mortality within 28 days was higher in those with FBG of 6.1–6.9 mmol/l (crude HR 2.06 [95% CI 1.20, 3.54]) and ≥7.0 mmol/l (crude HR 3.54 [95% CI 2.33, 5.38]), respectively (Table 2).
T205 19055-19208 Sentence denotes Compared with patients with FBG of 6.1–6.9 mmol/l, mortality within 28 days was higher in those with FBG ≥7.0 mmol/l (crude HR 1.72 [95% CI 1.05, 2.84]).
T206 19209-19437 Sentence denotes Meanwhile, compared with patients with CRB-65 score of 0, mortality within 28 days was higher in those with CRB-65 of 1–2 (crude HR 4.35 [95% CI 2.81, 6.72]) and 3–4 (crude HR 13.80 [95% CI 5.99, 31.80]), respectively (Table 2).
T207 19438-19587 Sentence denotes Compared with patients with CRB-65 score of 1–2, mortality within 28 days was higher in those with CRB-65 of 3–4 (crude HR 3.18 [95% CI 1.46, 6.89]).
T208 19588-20105 Sentence denotes Fig. 2 Kaplan–Meier survival curves (showing cumulative mortality and 95% CI) for COVID-19 patients stratified in terms of FBG or CRB-65 score at admission. (a) Kaplan–Meier survival curves of all COVID-19 patients stratified by FBG; (b) Kaplan–Meier survival curves of all COVID-19 patients stratified by CRB-65 score; (c) Kaplan–Meier survival curves of COVID-19 patients with a CRB-65 score of 0, stratified by FBG; (d) Kaplan–Meier survival curves of COVID-19 patients with a CRB-65 score of >0, stratified by FBG
T209 20107-20140 Sentence denotes FBG and CRB-65 score at admission
T210 20141-20189 Sentence denotes CRB-65 score is a measure of pneumonia severity.
T211 20190-20345 Sentence denotes The interaction between trends across FBG and CRB-65 scores did not reach statistical significance (p = 0.1112 for crude and 0.2243 for adjusted analyses).
T212 20346-20527 Sentence denotes Higher FBG levels were associated with increased mortality in the group with a CRB-65 score of 0 (Fig. 2c, ptrend < 0.0001) and with a CRB-65 score of >0 (Fig. 2d, ptrend = 0.0044).
T213 20528-20802 Sentence denotes In patients with a CRB-65 score of 0, mortality within 28 days was higher in the group with FBG ≥7.0 mmol/l (crude HR 6.57 [95% CI 2.65, 16.27]) and with FBG 6.1–6.9 mmol/l (crude HR 3.42 [95% CI 1.51, 10.19]) when compared with the group with FBG <6.1 mmol/l, respectively.
T214 20803-20955 Sentence denotes No statistically significant difference was found between the groups with FBG ≥7.0 mmol/l (crude HR 1.92 [95% CI 0.74, 4.99]) and FBG of 6.1–6.9 mmol/l.
T215 20956-21131 Sentence denotes In patients with a CRB-65 score of >0, mortality within 28 days was higher in the group with FBG ≥7.0 mmol/l (crude HR 1.99 [95% CI 1.24, 3.20]) compared with FBG <6.1 mmol/l.
T216 21132-21396 Sentence denotes No statistically significant difference was found between the groups with FBG of 6.1–6.9 mmol/l and FBG <6.1 mmol/l (crude HR 1.44 [95% CI 0.77, 2.70]), or between the groups with FBG ≥7.0 mmol/l and FBG of 6.1–6.9 mmol/l group (crude HR 1.38 [95% CI 0.77, 2.48]).
T217 21398-21447 Sentence denotes FBG at admission and complications within 28 days
T218 21448-21538 Sentence denotes Then, we analysed the relationship between the FBG and complications in COVID-19 patients.
T219 21539-21722 Sentence denotes The number of patients who had complications within 28 days in the groups with FBG <6.1 mmol/l, 6.1–6.9 mmol/l and ≥7.0 mmol/l was 86 (14.2%), 48 (7.9%) and 103 (17.0%), respectively.
T220 21723-21917 Sentence denotes The number of patients without complications within 28 days in the groups with FBG <6.1 mmol/l, 6.1–6.9 mmol/l and ≥7.0 mmol/l was 243 (40.2%), 52 (8.6%), and 73 (12.1%), respectively (Table 1).
T221 21918-22139 Sentence denotes Compared with patients with admission FBG <6.1 mmol/l, patients with admission FBG ≥7.0 mmol/l (OR 3.99 [95% CI 2.71, 5.88]) and 6.1–6.9 mmol/l (OR 2.61 [95% CI 1.64, 4.41]) had higher levels of in-hospital complications.
T222 22141-22151 Sentence denotes Discussion
T223 22152-22301 Sentence denotes The ongoing COVID-19 pandemic is taking a heavy toll worldwide and effective measures have to be taken to minimise its impact and to lower mortality.
T224 22302-22518 Sentence denotes Previous studies have shown that diabetes and acute uncontrolled hyperglycaemia (defined as blood glucose >10 mmol/l twice within any 24 h period) are related to morbidity and/or mortality from COVID-19 [13, 21, 25].
T225 22519-22712 Sentence denotes Nonetheless, so far, no research effort has been directed at whether the admission FBG level is an independent predictor of mortality in COVID-19 patients without previously diagnosed diabetes.
T226 22713-22986 Sentence denotes This two-centre retrospective study shows, for the first time, that elevated FBG (≥7.0 mmol/l) at admission is independently associated with increased 28-day mortality and percentages of in-hospital complications in COVID-19 patients without previous diagnosis of diabetes.
T227 22987-23184 Sentence denotes Our multivariable Cox regression analysis showed that FBG, CRB-65 score, age and sex were independently associated with 28-day mortality in COVID-19 patients without previous diagnosis of diabetes.
T228 23185-23376 Sentence denotes In a study involving 191 COVID-19 patients, advanced age, a high Sequential Organ Failure Assessment (SOFA) score and a D-dimer level greater than 1 μg/l were risk factors for mortality [21].
T229 23377-23612 Sentence denotes Because of differences in patient composition, their study failed to reveal any significant difference for sex, although the proportion of male patients in the non-survivor group was higher than in the surviving group (68.4% vs 49.7%).
T230 23613-23789 Sentence denotes Hyperglycaemia and/or diabetes were identified to be risk factors for morbidity and mortality caused by infection with community-acquired pneumonia (CAP), SARS and MERS [9–12].
T231 23790-23922 Sentence denotes Consistent with the studies on CAP [9, 10], our results indicate that admission FBG is a significant prognostic factor for COVID-19.
T232 23923-24086 Sentence denotes Another analysis of COVID-19 patients with ARDS showed that FBG is related to the occurrence of ARDS, but not associated with the death of patients with ARDS [26].
T233 24087-24288 Sentence denotes We have, for the first time, performed a stratified analysis of different FBG levels in a larger population and demonstrated that FBG ≥7.0 mmol/l is critical to the prognosis of patients with COVID-19.
T234 24289-24373 Sentence denotes Our data also show that non-survivors are more likely to have serious complications.
T235 24374-24486 Sentence denotes In addition, we demonstrate that the incidence of in-hospital complications increases with the elevation of FBG.
T236 24487-24745 Sentence denotes The CRB-65 score is a quick and convenient indicator for judging the severity of pneumonia [27]; we have also shown that FBG ≥7.0 mmol/l is associated with increased mortality in participants, regardless of whether the patient’s CRB-65 score is 0 or greater.
T237 24746-24876 Sentence denotes Patients with FBG >6.1 mmol/l accounted for 45.6% (276/605) and a total of 29.1% (176/605) patients had blood glucose ≥7.0 mmol/l.
T238 24877-25047 Sentence denotes These results indicate that our study included both undiagnosed diabetic patients and non-diabetic patients with hyperglycaemia caused by an acute blood-glucose disorder.
T239 25048-25264 Sentence denotes Similarly to a previous study, COVID-19 patients might suffer from stress hyperglycaemia [10] and critically ill patients may develop acute insulin resistance, manifested by hyperglycaemia and hyperinsulinaemia [28].
T240 25265-25445 Sentence denotes Patients with conditions not related to diabetes, such as severe sepsis, systemic inflammatory response syndrome (SIRS) and traumatic brain injury tend to have hyperglycaemia [28].
T241 25446-25568 Sentence denotes Hyperglycaemia at admission to the intensive care unit (ICU) is directly related to increased mortality or morbidity [29].
T242 25569-25691 Sentence denotes At the same time, drugs, such as antibiotics and corticosteroids, could also elevate serum glucose concentration [30, 31].
T243 25692-25917 Sentence denotes In particular, corticosteroids may impair glucose tolerance by promoting gluconeogenesis in the liver, reducing glucose uptake and utilisation in peripheral tissues and increasing the effects of other glycaemic hormones [31].
T244 25918-26068 Sentence denotes It is recommended that close attention be paid to hospitalised patients, regardless of whether they have been previously diagnosed as having diabetes.
T245 26069-26200 Sentence denotes Although insulin treatment for critically ill patients has become a standard of care, efficacy might well vary with different ICUs.
T246 26201-26399 Sentence denotes A study published in 2001 reported that intensive insulin therapy with blood glucose maintained at or below 6 mmol/l reduced morbidity and mortality in critically ill patients in surgical ICUs [32].
T247 26400-26573 Sentence denotes However, subsequent studies on intensive insulin therapy of critically ill patients in medical ICUs showed that this treatment could reduce morbidity but not mortality [33].
T248 26574-26801 Sentence denotes The debate over this issue remains, and a study published in 2009 found that intensive glycaemic control could increase mortality in adults in ICUs, but increasing target glucose levels to 10 mmol/l could reduce mortality [34].
T249 26802-27005 Sentence denotes A recent review separately examined surgical and medical patients and suggested that, to treat hyperglycaemia, insulin therapy should be used to maintain the glucose level between 8 mmol/l and 10 mmol/l.
T250 27006-27180 Sentence denotes This treatment could reduce the mortality and morbidity resulting from high FBG and lower the occasional risk of hypoglycaemia associated with intensive insulin therapy [35].
T251 27181-27216 Sentence denotes This study has several limitations.
T252 27217-27255 Sentence denotes First, this was a retrospective study.
T253 27256-27436 Sentence denotes Second, we did not cover HbA1c, a long-term glycaemic control indicator that helps distinguish patients with poor long-term glycaemic control from those with stress hyperglycaemia.
T254 27437-27838 Sentence denotes Finally, because our results were premised only on the glucose levels at admission, we might have underestimated the risks associated with hyperglycaemia (assuming that patients with the highest glucose levels are more likely to be treated in the hospital), and we did not have sufficient data to study the effect of glucose-lowering treatment (e.g. insulin, metformin) on the outcome of our patients.
T255 27839-27998 Sentence denotes However, we believe that acute hyperglycaemia is more important than long-term glycaemic control in predicting the prognosis of hospitalised COVID-19 patients.
T256 27999-28157 Sentence denotes In conclusion, FBG ≥7.0 mmol/l at admission is an independent predictor for 28-day mortality in patients with COVID-19 without previous diagnosis of diabetes.
T257 28158-28351 Sentence denotes Glycaemic testing and control should be recommended for all COVID-19 patients even if they do not have pre-existing diabetes, as most COVID-19 patients are prone to glucose metabolic disorders.
T258 28352-28533 Sentence denotes During a pandemic of COVID-19, FBG can facilitate the assessment of prognosis and early intervention of hyperglycaemia to help improve the overall outcomes in treatment of COVID-19.