Abstract:

Objective To investigate the role of blood glucose variability in the prognosis of patients with severe and critical（collectively referred to as severe） corona virus disease 2019（COVID-19） patients. Methods The general data of 83 patients with severe COVID-19 were collected,and acute physiological and chronic health evaluation Ⅱ（APACHEⅡ） score when transferred to intensive care unit（ICU）,dynamic glucose variability data within 72 h [mean glucose fluctuation amplitude（Glu-MAGE）,glucose-coefficient of variation（Glu-CV）,glucose instability index（Glu-GLI） and 72 h mean glucose] were recorded. According to the prognosis of 28 d,the patients were classified into survival group and death group. According to the patients' average 72 h blood glucose,the cut-off values of 11.1 and 7.8 mmol/L,the patients were classified into >11.1 mmol/L ,7.8-11.1 mmol/L and <7.8 mmol/L groups. Based on the results 72 h Glu-CV,the patients were classified into 4 groups by quartiles（Q₁-Q₄）. According to the history of diabetes,the patients were classified into non-diabetic group and diabetic group. Blood glucose variability and mortality were compared in each group. Results The age,APACHEⅡ score,72 h mean glucose,Glu-MAGE,Glu-GLI,Glu-CV of death group were higher than those of survival group（P<0.05）. In the >11.1 mmol/L group,Glu-MAGE,Glu-CV were higher than those in 7.8-11.1 mmol/L and <7.8 mmol/L groups（P<0.05）. There was no statistical significance between 7.8-11.1 mmol/L group and <7.8 mmol/L group（P>0.05）. The other items were not statistically significant among the 3 groups（P>0.05）. The 28 d mortality increased with the increase of blood glucose,and the difference among the 3 groups had statistical significance（P<0.05）. In Q₁-Q₄ groups,the 28 d mortality rate of 28 d of diabetic patients was higher than that of non-diabetic patients（P<0.05）. With or without diabetes,the 28 d mortality rate increased with the increase of Glu-CV（P<0.05）. Conclusions Death risk in patients with severe COVID-19 increases with the increasing of blood glucose variability.

Key words: Glucose variability, Corona virus disease 2019, Prognosis