Caracterización clínica, según niveles de glucemia, de pacientes hospitalizados por COVID-19: serie de casos
Clinical characteristics of patients hospitalized with COVID-19 according to glycemia levels: Case series
Resumen
La hiperglucemia con o sin diabetes en pacientes hospitalizados con COVID-19 se asocia con complicaciones. No existe información del problema en nuestro entorno. El objetivo del estudio fue comparar las características y curso clínico intrahospitalario de los pacientes con diagnóstico de COVID-19 que presentaron o no hiperglucemia durante su hospitalización. Estudio retrospectivo, observacional, de revisión de historias clínicas de pacientes hospitalizados con COVID-19. Se usó el formulario desarrollado por ISARIC y OMS para recopilar datos. Siguiendo los objetivos glucémicos estándar en pacientes hospitalizados, se definió como hiperglucemia, al valor en ayunas igual o mayor de 140 mg/dL. Se incluyeron 148 pacientes, 97 (65,5%) hombres y 51 mujeres (34,5%), con edad promedio de 64,1±16,1 años, de los cuales 42 (28,4%), refirieron antecedente de diabetes, 60 (40,5%) presentaron hiperglucemia intrahospitalaria y 32 (53,3%) de estos casos no reportaron diabetes previa. Los pacientes con hiperglucemia tenían mayor edad, recibieron más corticoides sistémicos (96,6 vs 82,6%; p=0,01), antibióticos (68,3 vs 44,3%; p=0,01), presentaron mayor alteración en la oxigenación de ingreso (SpO2 88,1±11,7% vs 92,8±5,5%, p=0,02; PaO2/FiO2, 194,4±119,7 vs 270,9±118,3, p<0,001), mayor puntaje de extensión de lesión pulmonar en la tomografía de tórax (14,9±5,7 vs 11,1±6,3; p<0,001) y marcadores inflamatorios al ingreso más alterados (PCR 6,73±3,61 vs 5,08±4,21; p<0,01, LDH 342,9±118,4 vs 296,5±161,4; p=0,01 y ferritina 687,7±373,2 vs 542,6±395,3; p=0,01). La mortalidad (34,5 vs 10,7%; p<0,001) y admisión a la UCI (43,3 vs 7,9%; p<0,001) fue mayor en los pacientes con hiperglucemia. La hiperglucemia en pacientes hospitalizados por COVID-19 es un marcador de mayor gravedad y mal pronóstico.
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