Factors associated with dexamethasone-induced hyperglycemia of COVID-19 severe pneumonia at Hua Hin Hospital

Abstract

Background: In 2019, a large outbreak of the COVID-19 virus spread throughout the world.         Hua Hin Hospital had 10,855 cases of COVID-19 infection, and 445 of those cases required dexamethasone to treat their pneumonia during hospitalization. Steroids caused many patients to have hyperglycemia. This led to the administration of insulin to lower blood sugar levels. In some cases, the high blood sugar level developed into diabetic ketoacidosis (DKA). DKA was found in 6 cases (1.3%) of pneumonia patients who had diabetes and were treated with dexamethasone. However, hyperglycemia was also detected in patients who did not have a preexisting diabetic condition. Therefore, it is important to monitor the risks associated with hyperglycemia and examine the clinical guideline for COVID-19 patients with pneumonia.

Objective: The purpose of this study was to explore the factors associated with hyperglycemia in COVID-19 patients with pneumonia who were treated with dexamethasone at Hua Hin Hospital.

Methods: This study was a retrospective analytical study. This study recruited the electronic medical records of COVID-19 patients with pneumonia, receiving dexamethasone without a history of hyperglycemia or diabetic comorbidities at Hua Hin Hospital from April 1, 2021, to March 31, 2022. The data were analyzed by percentage, mean, and standard deviation. The factors that influenced hyperglycemia were analyzed by Chi-square test and independent t-test.

Result: Of 275 cases, there were 112 male patients (40.7%) and 163 female patients (59.3%). The average age was 54+18.15 years, with 118 underlying diseases (42.9%). The most underlying diagnoses were hypertension (76 cases, 27.6%), heart disease (17 cases, 6.2%), and chronic kidney disease stage V (6 cases, 2.2%), respectively. Most of the body mass index (BMI) categories were obesity level 1 (BMI 25-29.9 kg/m²), with 93 cases (33.8%). The average C-Reactive protein (CRP) level was 64+66.62 mg/l, normal white blood cells (4000-10,000 cells/mm³), and 161 cases (58.5%). Dexamethasone dose did not exceed 16 mg/day in 174 patients (63.3%), and the duration of dexamethasone was 6-10 days in 192 patients (69.8%). We found that hyperglycemia occurred in 142 patients (51.6%) after receiving dexamethasone. The presence of hypertension, white blood cell count, CRP level, and the dose and duration of dexamethasone were all associated with the incidence of hyperglycemia in COVID-19 patients with pneumonia. Other factors, such as sex, BMI, underlying heart disease, lung disease, cerebrovascular disease, or immunocompromised host had no effect on the occurrence of hyperglycemia.

Conclusion: Factors that may increase the risk of hyperglycemia in COVID-19 patients with pneumonia at Hua Hin Hospital after receiving dexamethasone include age, hypertension, and the dose of the drug. The physician should monitor these patients carefully, as well as those who have high blood pressure, high white blood cell count, high CRP level, and long-term treatment with dexamethasone. It is recommended that random blood sugar test should be placed in the hospital guidelines.