Hyperglicemia at the Admission as Predictor of Severity
Authors: Hernandez Valdez Astrid Paola , Castillo Emilio Jose , Rios Gabriel Antonio , Urízar María Alejandra Cárcamo , Godinez Luis Benjamin 
Published: May 2021

Background: Diabetes Mellitus is a factor for the development of micronagiopathies, it is well known at the level of retina, renal and peripheral nervous system. However, it is important to mention that high levels of glucose have deleterious effects on the walls of the vessels, causing microangiopathic damage to the lung, consequently this leads to pulmonary dysfunction. There is local oxidative stress, increased vascular permeability, producing changes in the secretion of the mucus that leads to reduced lung volumes, lung diffusion capacity, decrease bronchodilation.

Knowing this complication at the pulmonary level derived from poor control of Diabetes Mellitus, diabetic pulmonary microangiopathy represents a challenge for the COVID-19 pandemic. There is a high prevalence of diabetic patients hospitalized for COVID-19 and the complications derived from this, that is why the idea arose to carry out this review and evaluate the impact that admission glucose levels have on the clinical evolution and prognosis of these patients. Elevated serum glucose levels have deleterious effects on the walls of blood vessels, leading to microangiopathy. Such a destructive process also involves the pulmonary circulation, where it is known as diabetic pulmonary microangiopathy. This hypothesis has been confirmed in histopathological examinations of the lung parenchyma, as well as in lung function tests. However, until now there have been no clinical implications of these findings.1

Histopathological evidence of pulmonary involvement in subjects with diabetes mellitus has included thickened pulmonary capillary basal plates and alveolar epithelial plates, the latter suggesting existing pulmonary microangiopathy. Abnormal lung function has been detected in some diabetic patients. Glycosylation-induced non-enzymatic alteration of lung connective tissue is the most likely pathogenetic mechanism underlying mechanical lung dysfunction in diabetic subjects. while the most sustainable explanation for altered pulmonary microangiopathy.2

Metodos:

This short review looks at the main findings, prospective cross-sectional analytical study, in Guatemala Central America that included 319 patients with COVID 19, hospitalized with comorbidities like type 2 Diabetes Mellitus, hypertension and chronic kidney disease as medical history. These patients did not have a history of pulmonary pathology and who required a low- and high-flow oxygen device since admission, presenting moderate and severe COVID-19. These laboratories were carried out in the first chemistry performed after the onset of respiratory symptoms in the arrival at the hospital. Chi square was used for categorical variables and t student for numeric variables for the rest of the variables. Results:

The study showed that in the severe group of patients the median age was 52 years old and in the moderate group it was 51. In the severe group of patients, a male gender predominance with 50.7% and 49.3% in moderate; showing the female sex 46% and 53% respectively. Regarding glucose levels at admission, there was a mean of 189mg / dl for severe patients and 156 mg / dl in moderate patients, with a P: 0.021. Conclusion:

The primary point in this study is to see how the correlation was measured since they had to be two numerical variables for it to be correlation. In this case, blood glucose and vascular damage, the most severe cases were related to blood glucose levels greater than 125 mg/dl. In our study, we conclude that the presence of glycemic levels below 125 mg/dl is a protective factor with respect to mortality with an OR 0.521 (CL 0.324–0.835, Po.007). That means, that those patients who are admitted with glycemic levels greater than 126 mg/d have twice the risk to die at 28 days of admission than those who do not have levels greater than 125mg/dl. In the same way, those patients who were admitted with less than 95% saturation were compared and there was no significant difference OR 1.174 (0.492–2.806, p0.822). 1. Kuziemski, Krzysztof Specjalski et a. lEndokrynol Pol. 2011; 62 (2): 171–6. Microangiopatía pulmonar diabética: ¿realidad o ficción? Publicated: Ewa Jassem. https://pubmed.ncbi.nlm.nih.gov/31637580/ 2. Krzysztof Kuziemski et al ¿Es el pulmón un “órgano diana” en la diabetes mellitus? Publicated: 2196023 https://pubmed.ncbi.nlm.nih.gov/19722145/