ABSTRACT
Objective: To assess the relationship between serum 1,5-anhydroglucitol (1,5-AG), a marker of glycemic variability, and mortality in COVID-19 patients. Method: Data from 64 hospitalized COVID-19 patients were collected between June 2020-February 2021 at Sinai Hospital (Baltimore, MD), including 9 patients who died in the hospital. Medical history, demographic variables, and biochemical measurements were taken at time of admission. Baseline means for fasting blood glucose and 1,5-AG were 143.5 mg/dL (SD 68.9) and 14.7 ug/mL (SD 8.8), respectively. HbA1c available in 40 patients-mean value 6.9% (SD 2.3). Result: Multivariate logistic regression analysis showed that only 1,5-AG (n=64) was an independent predictor of mortality (AUC = 0.69, p value 0.017). Fasting glucose (n=64) and HbA1c (n=40) were not statsically significant with AUCs of 0.60 (p value 0.322) and 0.58 (p value 0.464), respectively. In an analysis of clinical variables, a combination of BMI and Age was predictive of mortality (AUC = 0.77, p value 0.004). Interestingly, when 1,5-AG was added to BMI and Age, the AUC increased to 0.94 (p value <0.0001). When fasting glucose was added to BMI and Age the AUC was 0.79 (p value 0.001). A cox regression analysis showed an OR (1,5-AG < 10 ug/mL) for mortality of 0.44 (95% CI 0.11, 1.85). Conclusion: 1,5-AG was an independent predictor of COVID-19 mortality. Fasting glucose and HbA1c showed no statistical significance to outcomes. The HbA1c findings confirm the results from other COVID-19 studies, but the finding that 1,5-AG outperformed fasting glucose in predicting mortality is new. 1,5-AG may provide important and unique information in the COVID-19 clinical setting. An algorithm of BMI, Age, and 1,5-AG may also be clinically useful.