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ОРИГИНАЛЬРЫЕ ИССЛЕДОВАНИЯ
Связь между уровнем глюкозы в крови, сопутствующими заболеваниями и исходами лечения пациентов с COVID-19 в больнице третичного звена
Пурани К., Навин Шри Л.А., Сандхия В., Дханашри Б., Картикеян Р., Мурали А., Рамалингам С.
Учебная больница и Институт медицинских наук и исследований, 641004, г. Коимбатур, Индия
Сопутствующие заболевания увеличивают риск тяжелого течения С0УШ-19 и повышают летальность. В Южной Индии проведено небольшое количество исследований, в которых оценивали сниженный уровень глюкозы в крови и наличие сопутствующих заболеваний в качестве прогностических показателей исходов у больных С0УЮ-19.
Цель исследования - изучение связи между уровнем глюкозы в крови, наличием сопутствующих заболеваний и исходом в качестве прогностического показателя С0УЮ-19.
Материал и методы. Проведен ретроспективный перекрестный анализ 593 подтвержденных случаев С0УЮ-19. Проанализированы демографические данные, сведения о сопутствующих заболеваниях [сахарный диабет (СД), заболевания сердца, печени и почек], результаты лабораторных исследований [уровень глюкозы в крови натощак, случайный уровень сахара в крови (КББ), С-реактивный белок]. Сравнивали средние значения непрерывных переменных с использованием двустороннего независимого ¿-критерия. Для оценки категориальных переменных использованы критерий х2 Пирсона и точный критерий Фишера. Для определения факторов риска, связанных с исходами, были рассчитаны отношения шансов (0К) и 95% доверительный интервал (ДИ). Различия считали статистически значимыми при р<0,05.
Результаты. В выборке мужчины составляли 66,78%, выздоровели 99,4% и не находились в отделении интенсивной терапии 91,6%. Средний возраст (+50) выживших и умерших пациентов составил 50,93+14,36 и 63,92+14,99 года соответственно. Исходы С0УЮ-19 были достоверно связаны с полом (р=0,036), сопутствующими заболеваниями (р=0,003), СД (р=0,014), КВБ (р=0,042), артериальной гипертензией (р=0,02), заболеваниями сердца (р=0,001). 0К составили 0,419 (95% ДИ 0,182-0,967) для пола, 2,403 (1,173-4,921) для сахарного диабета, 1,953 (1,014-3,759) для (^ВБ, 2,146 (1,117-4,124) для артериальной гипертензии.
Заключение. В исследовании установлено значительное влияние СД и уровня глюкозы крови на исходы С0УЮ-19, наряду с другими сопутствующими заболеваниями.
Финансирование. Исследование не имело финансовой поддержки. Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.
Вклад авторов. Концепция, дизайн, отбор участников исследования и пациентов, получение информированного согласия, интерпретация лабораторных отчетов, сбор, мониторинг и интерпретация данных, составление окончательного отчета, подготовка к публикации - Пуран К.; дизайн, отбор участников исследования и пациентов, интерпретация лабораторных отчетов, интерпретация данных, статистический анализ, составление окончательного отчета, подготовка к публикации - Навин Шри Л.А.; статистический анализ и интерпретация - Сандхия В.; интерпретация лабораторных отчетов, интерпретация данных, статистический анализ и обработка, составление окончательного отчета - Дханашри Б.; ведение данных, сбор и мониторинг
Ключевые слова:
COVID-l9; глюкоза крови; сахарный диабет; исходы; сопутствующая патология
данных, составление окончательного отчета - Картикеян Р.; ведение данных, сбор и мониторинг данных, составление итогового отчета - Мурали А.; надзор, лабораторные исследования, ведение, сбор и мониторинг данных, рецензирование и окончательная подготовка рукописи - Рамалингам С.
Для цитирования: Пурани К., Навин Шри Л.А., Сандхия В., Дханашри Б., Картикеян Р., Мурали А., Рамалингам С. Связь между уровнем глюкозы в крови, сопутствующими заболеваниями и исходами лечения пациентов с COVID-19 в больнице третичного звена // Инфекционные болезни: новости, мнения, обучение. 2023. Т. 12, № 4. С. 33-38. DOI: https://doi.org/10.33029/2305-3496-2023-12-4-33-38 (англ.)
Статья поступила в редакцию 04.04.2023. Принята в печать 09.10.2023.
Association between blood glucose levels and other comorbidities with outcomes of COVID-19 patients in a tertiary care hospital
Poorani K., Naveen Sri L.A., Sandhiya V., Dhanashree B., Karthikeyan R., Murali А., Ramalingam S.
PSG Institute of Medical Sciences and Research, 641004, Coimbatore, India
Comorbidities increase the risk of severe COVID-19 and in turn higher mortality. There is a paucity of studies in South India that evaluated the presence of impaired blood glucose levels and other comorbidities as indicators of COVID-19 outcomes.
Aim: to study the association of blood glucose levels and other comorbidities with the outcome of COVID-19 patients and its role as a predictive indicator of outcome in COVID-19 patients.
Material and methods. A retrospective cross-sectional analysis was conducted on 593 COVID-19 confirmed cases. Demographic data, presence of comorbidities like diabetes mellitus (DM), heart, liver, and renal diseases, laboratory tests like fasting blood sugar (FBS), random blood sugar (RBS), C-reactive protein, etc. were collected. Using two-tailed independent t-test means of continuous variables were compared. Pearson's Chi square and Fisher's exact tests were used to evaluate the association of categorical variables with outcomes. Odds ratio (OR), and 95% confidence interval (CI) were calculated to determine the risk factors associated with outcomes. P values <0.05 was considered significant.
Results. Majority of the cases were men (66.78%), live (99.4%), and non intensive care unit (non-ICU) (91.6%). Mean (±SD) ages of live and dead cases were 50.93+14.36 and 63.92+14.99 years, respectively. Outcomes of cases were significantly associated with sex (p=0.036), comorbidities (p=0.003), DM (p=0.014), RBS (p=0.042), systemic hypertension (p=0.02), heart disease (p=0.001), etc., and the risk estimates showed ORs as follows: 0.419 (95% CI 0.182-0.967) for sex, 2.403 (95% CI 1.173-4.921) for DM, 1.953 (95% CI 1.0143.759) for RBS, 2.146 (95% CI 1.117-4.124) for hypertension, etc.
Conclusion. The study highlights the significant influence of DM and blood sugar levels on COVID-19 disease outcomes, along with other comorbidities, in South India.
Conflict of interest. The authors do not declare any conflicts of interest.
Funding. This study did not receive any specific funding or grants from public, government, or not-for-profit sectors. Contribution. Concept, design, selection and recruitment of participants and patients, informed consent, laboratory report interpretation, data collection, monitoring, and interpretation, maintenance of data, drafting final report, publication - Pooran K.; design, selection and recruitment of participants and patients, laboratory report interpretation, data interpretation, statistical analysis and interpretation, drafting final report, publication - Naveen Sri L.A.; statistical analysis and interpretation - Sandhiya V.; laboratory report interpretation, data interpretation, statistical analysis and interpretation, drafting final report -Dhanashree B.; maintenance of data, data collection and monitoring, drafting final report -Karthikeyan R.; maintenance of data, data collection and monitoring, drafting final report -Murali A.; supervision, laboratory investigations, maintenance of data, data collection and monitoring, reviewing and final drafting of manuscript - Ramalingam S.
For citation: Poorani K., Naveen Sri L.A., Sandhiya V., Dhanashree B., Karthikeyan R., Murali A., Ramalingam S. Association between blood glucose levels and other comorbidities with outcomes of COVID-19 patients in a tertiary care hospital. Infektsi-onnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2023; 12 (4): 33-8. DOI: https://doi. org/10.33029/2305-3496-2023-12-4-33-38 Received 04.04.2023. Accepted 09.10.2023.
Keywords:
COVID-19; blood glucose; diabetes mellitus; outcomes; comorbidity
Coronavirus disease (COVID-19) emerged as a pandemic in December 2019. Till date COVID-19 has affected 594 million people worldwide, with a mortality of 6 million. India alone has witnessed over 44 million cases and half a million deaths [1]. Several risk factors have been identified that lead to disease progression to severe COVID-19 needing
intensive care and can result in death. These risk factors include demographic factors such as age and sex, various laboratory test indicators including peripheral blood cell counts, C-reactive protein, alanine, and aspartate transaminases [serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic-pyruvic transaminase (SGPT)], etc., and the presence of comorbidities
Like hypertension, diabetes, obesity, cerebrovascular disease, chronic obstructive pulmonary disease, chronic Liver, and kidney diseases [2-4].
Arterial hypertension contributes to increased risk of severe illness due to COVID-19. Angiotensin converting enzyme-2 (ACE-2) receptor is said to enable the entry of severe acute respiratory syndrome (SARS) COVID-2 virus into the host cell, and drugs modulating ACE-2 is generally prescribed for hypertension, that increases susceptibility to COVID-19 and hence, poorer outcomes [5]. Similarly, increased severity of COVID-19 infection course with other pre-existing comorbidities like obesity, cerebrovascular diseases, etc., have been suggested in different studies [2-4].
Blood glucose levels are reported to be positively correlated with COVID-19, where patients with hyperglycemia have a higher mortality rate (7.3%) than those with normal blood glucose levels (0.9%) [6]. In addition, hyperglycemia, and a history of diabetes during admission was noted as a predictor of poor COVID-19 prognosis, with twice the risk of mortality and severe COVID in diabetes mellitus (DM) patients [7, 8]. In patients with DM, pre-DM, and obesity, impaired glucose metabolism is said to be the common factor that increased the risk of severe COVID-19 [9]. A study postulated that elevated glucose levels and aerobic glycolysis in monocytes can promote viral replication increasing susceptibility to COVID-19 infection [10]. Presence of prediabetes or newly diagnosed at the time of admission increases the incidence of admission to intensive care unit (ICU), when compared to absence of diabetes [11]. This highlights the need to evaluate blood glucose levels in COVID-19 patients, in addition to other comorbidities. The present study evaluated the association of blood glucose levels with outcome of COVID-19 patients at a tertiary care clinic and its role as a predictive indicator of outcome inCOVID-19 patients.
Material and methods
This was a cross-sectional study using retrospective data of COVID-19 confirmed patients admitted to a tertiary care hospital. The study was approved by Institutional Human ethics Committee (IHEC) (PSG/IHEC/2021/Appr/Exp/030). The medical records of 593 patients admitted between April 2020 to December 2020 were analyzed and their outcomes recorded.
Patients with confirmed and treated COVID-19 who were both ICU and non-ICU inpatient records were included for the study. Patient records of pregnant women and children below 18 years and patients with missing data were not included for the analyses. Demographic data, presence of comorbidities like diabetes mellitus, heart, liver, and renal diseases, laboratory tests conducted including fasting blood sugar (FBS), random blood sugar (RBS), HbA1c, C-reactive protein (CRP), red blood cell (RBC) and white blood cell (WBC) count, creatinine, urea levels, etc. were collected.
Statistical analysis
Data was analyzed using SPSS software version 25.0 and Microsoft Excel. Continuous data was represented as mean ± standard deviation (SD). Categorical data was represented as percentage and frequencies. Two-tailed independent t-test was
Table 1. Mean ± SD values of various laboratory test findings
Laboratory tests Range Mean ± SD (n=593)
Fasting blood sugar, mg/dl 50-352 166.21± 89.002
Random blood sugar, mg/dl 38-628 167.28±106.570
HbAlc, % 4.7-16.3 7.78±2.255
PaO2 75-100 76.53±18.661
PaCO2 32-42 33.65±6.142
SpO2, % 57-100 98±5.329
Arterial pH 7.23-7.8 8.46±9.820
Lung volume 7.390
C-reactive protein, mg/dl 0.06-14.2 1.20±10.953
Erythrocyte sedimentation rate, mm/hr 1-160 32.00±24.749
Haemoglobin, gm/dl 6.9-17.5 13.10±1.756
Red blood cells (million cells/mm3) 2.11-6.28 4.67±0.613
White blood cells, *109/L 2.2-34.8 6.00±3.465
Urea, mmol/L 6-20 23.00±18.250
Creatinine, mg/dl 0.4-1.3 0.80±0.673
Total bilirubin 0.2-5.9 0.40±0.404
Direct bilirubin, mg/dl 0.1-5.7 0.20±0.2991
Indirect bilirubin 0.1-1.9 0.20±0.189
SGPT, U/L of blood serum 3-150 22.00±27.786
SGOT, U/L of blood serum 10-150 27.00±29.147
Alkaline phosphatase, IU/L 17-264 72.37±69.00
Gamma-glutamyl transferase, IU/L 5-150 48.10±33.00
Albumin 2.1-5.2 3.90±3.900
Globulin 1.9-6.2 3.38±3.300
Note. HbAlc - Haemoglobin Alc; PaO2 - partial pressure of oxygen in arterial blood; PaCO2 - partial pressure of carbon dioxide in arterial blood; SpO2 - oxygen saturation; SGPT -serum glutamic-pyruvic transaminase; SGOT - serum glutamic-oxaloacetic transaminase.
used to compare means of continuous variables. Pearson's chi square and Fisher's exact tests were used to evaluate the association of categorical variables with outcomes (live and death). Odds ratio (OR), and 95% confidence interval (CI) were calculated to determine the risk factors associated with outcomes. Statistical significance was considered at P values less than 0.05.
Results
The medical records of 593 confirmed COVID-19 patients were included in this study, among which 396 were males (66.78%) and 197 were females (33.22%). Patients' age ranged between 15-99 years with a mean (±SD) age of live patients being 50.93+14.36 years and of dead patients being 63.92+14.99 years, which was significantly different (p=0.000). Majority of the patients manifested comorbidities (n=370, 62.4%), and were not admitted to the ICU (n=543, 91.6%). Of total 593 patients, 554 were alive (93.4%) and 39 were dead (6.6%).
Mean values of laboratory tests conducted and frequencies of comorbidities manifested by the patients are summarized in tables 1 and 2. Table 3 lists the comparison of means of laboratory findings between live and dead patients. Highly significant difference was observed between the outcome groups with
Table 2. Summary of comorbidities manifested by the patients
Co-morbidities Sub-category n (%)
DM Absent 306 (51.6)
Present 282 (47.6)
RBS category Normal 406 (68.5)
Higher 187 (31.5)
No DM 280 (47.2)
DM category Known DM 282 (47.6)
Newly DM 31 (5.2)
Systemic Absent 404 (68.1)
hypertension Present 189 (31.9)
Heart diseases Absent 544 (91.7)
Present 49 (8.3)
Chronic obstructive Absent 573 (96.6)
pulmonary disease Present 19 (3.2)
PTBCP Absent 590 (99.5)
Present 2 (0.3)
Thyroid Absent 561 (94.6)
Present 20 (3.4)
Cerebrovascular Absent 587 (99)
accident Present 6 (1)
Seizure Absent 591 (99.7)
Present 2 (0.3)
Liver diseases Absent 590 (99.5)
Present 3 (0.5)
Kidney diseases Absent 586 (98.8)
Present 7 (1.2)
Others Absent 544 (91.7)
Present 30 (5.1)
Note. RBS - random blood sugar; DM - diabetes mellitus; PTBCP - pulmonary tuberculosis in continuation phase.
respect to mean pulse, RR interval (inter-beat interval), oxygen saturation (SpO2), CRP, WBC, urea, creatinine, total, direct and indirect bilirubin (TBIL, DBIL, IBIL), aspartate and alanine transaminases (serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic-pyruvic transaminase (SGPT)), alkaline phosphatase (ALP), albumin, and globulin (p<0.0001). Significant differences, however, were observed with respect to mean partial pressure of oxygen (PaO2) (p=0.002), partial pressure of carbon dioxide (PaCO2) (p=0.032), SGPT (p=0.019), gamma- glutamyl transferase (GGT) (p=0.012) values between the outcome groups.
Using Pearson's Chi square test and Fisher's exact test, significant association of outcomes, were observed with sex (p=0.036), comorbidities (p=0.003), diabetes mellitus (p=0.014), RBS (p=0.042), systemic hypertension (p=0.02), heart disease (p=0.001), liver (p=0.012), and renal abnormalities (p=0.008), see Table 4.
Univariate analysis of risk estimate in patients with COVID-19 revealed odds ratio of 0.419 (95% CI 0.182-0.967) for sex, 3.542 (95% CI 1.460-8.593) for comorbidities, 2.403 (95% CI 1.173-4.921) for diabetes mellitus, 1.953 (95% CI 1.014-3.759) for RBS, 2.146 (95% CI 1.117-4.124) for systemic hypertension (SHT), 4.553 (95% CI 2.069-10.023) for heart diseases, 29.892 (95% CI 95% CI, 2.649-333.311) for liver diseases and 11.458 (95% CI 2.470-53.153) for renal diseases, see Table 5.
Discussion
Several studies points at different risk factors and markers in patients with severe COVID-19 complications
Table 3. Comparison of means of laboratory findings
Variable Live Dead |
n mean (SD) n I mean (SD9) 1
Pulse on admission 553 88.23 (10.67) 39 96.08 (21.96)
G.GGG*
P value
RR on admission 553 21.01 (4.99) 39 25.97 (9.13) G.GGG*
SpO2 490 97.26 (2.73) 37 88.44 (15.47) G.GGG*
PaO2 30 82.86 (18.82) 18 65.97 (13.03) G.GG2*
PaCO2 29 34.5 (6.3) 19 30.64 (5.23) G.G32*
Arterial pH 63 7.4 (0.06) 24 11.24 (18.69) 0.103
C-reactive protein 214 3.85 (5.81) 15 20.23 (34.24) G.GGG*
Erythrocyte sedimentation rate 220 35.86 (24.83) 11 38.27 (23.99) 0.753
Haemoglobin 534 12.99 (1.71) 38 12.83 (2.37) 0.600
Red blood cells 127 4.62 (0.6) 25 4.58 (0.71) 0.756
White blood cells 531 6.42 (2.59) 37 13.27 (6.71) G.GGG*
Urea 527 25.26 (12.66) 36 59.11 (42.86) G.GGG*
Creatinine 532 0.86 (0.59) 37 1.32 (1.34) G.GGG*
Total bilirubin 536 0.5 (0.37) 35 0.87 (0.68) G.GGG*
Direct bilirubin 536 0.22 (0.29) 35 0.43 (0.39) G.GGG*
Indirect bilirubin 536 0.28 (0.17) 35 0.45 (0.35) G.GGG*
SGPT 536 28.96 (27.58) 35 40.31 (29.11) G.G19*
SGOT 536 32.07 (24.27) 35 69.8 (59.97) G.GGG*
Alkaline phosphatase 536 72.07 (24.11) 35 93.29 (43.26) G.GGG*
Gamma-glutamyl transferase 537 46.8 (47.39) 35 67.94 (58.72) G.G12*
Albumin 532 3.94 (0.48) 37 3.32 (0.6) G.GGG*
Globulin 532 3.36 (0.5) 37 3.69 (0.67) G.GGG*
Note. Indicates significance at p<0.05; HbAlc - Hemoglobin A1c; PaO2 - partial pressure of oxygen in arterial blood; PaCO2 - partial pressure of Carbon-dioxide; SpO2 - oxygen saturation; SGPT - serum glutamic-pyruvic transaminase; SGOT - serum glutamic-oxaloacetic transaminase.
Table 4. Association of categorical variables with patient outcomes
Variables Outcomes Chi squared value P value
live, n (%) I dead, n (%)
Sex Male 364 (91.9) 32 (8.1) 4.389 0.036*
Female 190 (96.4) 7 (3.6)
Co Morbidity Absent 217 (97.3) 6 (2.7) 8.785 0.003*
Present 337 (91.1) 33 (8.9)
DM analysis Absent 269 (96.1) 11 (3.9) 6.055 0.014*
Present 285 (91.1) 28 (8.9)
RBS category 2 Within limits 385 (94.8) 21 (5.2) 4.132 0.042*
Above limits 169 (90.4) 18 (9.6)
Systemic Within limits 384 (95) 20 (5) 5.456 0.02*
hypertension Above limits 170 (89.9) 19 (10.1)
Heart Disease* Absent 515 (94.7) 29 (5.3) 16.631 0.001*
Present 39 (79.6) 10 (20.4)
Thyroid* Within limits 525 (93.6) 36 (6.4) 0.406 0.381
Above limits 18 (90) 2 (10)
CVA* Absent 549 (93.5) 38 (6.5) 1.004 0.336
Present 5 (83.3) 1 (16.7)
Seizure* Absent 552 (93.4) 39 (6.6) 0.141 0.999
Present 2 (100) 0 (0)
Liver abnormality* Absent 553 (93.7) 37 (6.3) 17.72 0.012*
Present 1 (33.3) 2 (66.7)
Renal abnormality* Absent 550 (93.9) 36 (6.1) 15.175 O.OOS*
Present 4 (57.1) 3 (42.9)
Others* Absent 512 (94.1) 32 (5.9) 9.167 0.01*
Present 24 (80) 6 (20)
Note. * - indicates significance at p<0.05; # - Fisher's exact test; DM - diabetes mellitus; CVA - cerebrovascular accident.
[2-4, 12]. Hematological markers such as lymphocyte count, neutrophil count, inflammatory markers like CRP, erythrocyte sedimentation rate, interleukin-6, creatine kinase, SGOT, and markers involved in coagulation, followed by acute respiratory distress syndrome (ADRS), which marks the critical stage of COVID-19, have been identified [12]. Other risk factors that has been found to increase the incidence of severe COVID-19 are hypertension, diabetes, cardiovascular and cerebrovascular diseases, etc. [4]. However, there is lacuna of research on risk factors involved in outcomes of COVID-19 patients in India.
Aging is known to cause changes in immune system, resulting in gradual decline in ability to fight infections and hence increasing susceptibility to coronavirus infections as well as determining progression and outcome of disease. Therefore, elderly population are most affected [13]. Among the cases included in this study, 93.4% were alive and 6.6% were dead. There was significant difference in mean age between the live and dead cases, where mean (SD) age of dead cases was 63.92 (14.99) years. A meta-analysis conducted by Starke et al., 2021, reported a 7.4% increase in risk of mortality with age, along with disease severity [14].
In the present study, sex (p=0.036), comorbidities like RBS (p=0.042), systemic hypertension (p=0.02), heart disease (p=0.001), liver (p=0.012), and renal abnormalities (p=0.008), were significantly associated with outcomes of COVID-19. A meta-analysis of studies conducted in India reported around 50.5% of COVID-19 cases who died had history of comorbidities, and diabetes was cited as the leading comorbidity, followed by chronic heart diseases and hypertension [15]. However, other
studies reported variable prevalence of diabetes, hypertension, heart disease, chronic kidney diseases, etc. [2, 4, 7, 16].
History of diabetes and fasting plasma glucose were previously reported as independent predictors of poor outcomes [7]. Several other studies highlighted the importance of imbalance in fasting blood glucose levels and diabetes in predicting outcomes of COVID-19 [17-20]. In the present study, however, RBS level (OR 1.953; 95% CI 1.014-3.759) and diabetes (OR 2.403; 95% CI 1.173-4.921) influenced the outcomes of the patients, along with other comorbidities. Patients with high RBS at admission were reported to be susceptible to poor outcomes, but there is a lacuna of studies
Table 5. Risk estimate of different variables
Variables Odds 95% Confidence interval
Ratio upper limit lower limit
Sex 0.419 0.182 0.967
Co Morbidity 3.542 1.460 8.593
DM analysis 2.403 1.173 4.921
RBS category 2 1.953 1.014 3.759
Systemic hypertension 2.146 1.117 4.124
Heart Disease 4.553 2.069 10.023
Thyroid 1.620 0.362 7.258
CVA 2.889 0.329 25.359
Seizure 0.934 0.914 0.954
Liver abnormality 29.892 2.649 333.311
Renal abnormality 11.458 2.470 53.153
Others 4 1.527 10.481
Note. DM - diabetes mellitus; CVA - cerebrovascular accident.
that could establish RBS as an independent predictor like that of FBS [19]. Nevertheless, monitoring glucose levels at admission is necessary, as even a small increase can substantially increase the risk of ICU admission or mortality [20].
The current study also found significant difference in mean values of different blood parameters like CRP, urea, creatinine, SGOT, SGPT, ALP, bilirubin, albumin, globulin, SpO2, PaO2, PaCO2, etc., between live and dead COVID-19 cases. Liu et al., reported higher WBC, CRP, creatine kinase, etc., in ICU patients [7], Gao et al., reported the role of high sensitivity CRP in monitoring progression of disease [2], and a meta-analysis showcased
elevated levels of CRP, SGOT, and SGPT in patients with severe COVID [3]. These marker patterns are indicated in severe disease patients compared to mild COVID and thus, could help risk stratification [12].
Conclusion
The present study conducted in a tertiary care centre in South India highlights the significant influence of diabetes and blood sugar levels on COVID-19 disease outcomes, along with other comorbidities.
АВТОР ДЛЯ КОРРЕСПОНДЕНЦИИ
Sudha Ramalingam - Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, India E-mail: drsudhapsg@gmail.com
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