Elevated glucose level leads to rapid COVID-19 progression and high fatality

Wenjun Wang, Mingwang Shen, Yusha Tao, Christopher K. Fairley, Qin Zhong, Zongren Li, Hui Chen, Jason J. Ong, Dawei Zhang, Kai Zhang, Ning Xing, Huayuan Guo, Enqiang Qin, Xizhou Guan, Feifei Yang, Sibing Zhang, Lei Zhang, Kunlun He

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Objectives: We aimed to identify high-risk factors for disease progression and fatality for coronavirus disease 2019 (COVID-19) patients. Methods: We enrolled 2433 COVID-19 patients and used LASSO regression and multivariable cause-specific Cox proportional hazard models to identify the risk factors for disease progression and fatality. Results: The median time for progression from mild-to-moderate, moderate-to-severe, severe-to-critical, and critical-to-death were 3.0 (interquartile range: 1.8–5.5), 3.0 (1.0–7.0), 3.0 (1.0–8.0), and 6.5 (4.0–16.3) days, respectively. Among 1,758 mild or moderate patients at admission, 474 (27.0%) progressed to a severe or critical stage. Age above 60 years, elevated levels of blood glucose, respiratory rate, fever, chest tightness, c-reaction protein, lactate dehydrogenase, direct bilirubin, and low albumin and lymphocyte count were significant risk factors for progression. Of 675 severe or critical patients at admission, 41 (6.1%) died. Age above 74 years, elevated levels of blood glucose, fibrinogen and creatine kinase-MB, and low plateleta count were significant risk factors for fatality. Patients with elevated blood glucose level were 58% more likely to progress and 3.22 times more likely to die of COVID-19. Conclusions: Older age, elevated glucose level, and clinical indicators related to systemic inflammatory responses and multiple organ failures, predict both the disease progression and the fatality of COVID-19 patients.

Original languageEnglish
Article number64
Number of pages13
JournalBMC Pulmonary Medicine
Issue number1
Publication statusPublished - 24 Feb 2021


  • COVID-19
  • Fatality
  • Progression
  • Risk factors

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