1,5-anhydroglucitol is a novel and independent predictor of mortality in patients with covid-19

ABSTRACT

Background: Fasting hyperglycemia and diabetes are the independent predictors of morbidity and mortality in patients with COVID-19. Glycemic fluctuations may be independently associated with poor prognosis in adult patients hospitalized for COVID-19. Hypothesis: We hypothesize that 1,5-anhydroglucitol (1,5-AG), a marker of glycemic variability, is strongly associated with in-hospital mortality in patients with COVID-19. Methods: Medical history, demographic variables, and laboratory measurements were collected within 48 hours of hospitalization in COVID-19 patients (n=64), including 9 patients who died in the hospital. Serum 1,5AG was measured by an enzymatic colorimetric assay (GlycoMark, Precision Diabetes, Inc. Raleigh, NC). Multivariate regression analysis was performed to assess the relation between fasting glucose, hemoglobin (Hb)A1c and 1,5-AG and mortality. Results: Baseline mean ± SD for fasting blood glucose,1,5-AG and HbA1c (available in 40 patients) were 143 ± 69 mg/dL and 14.7 ± 8.8 ug/mL and 6.9±2.3%, respectively. Only 1,5-AG was an independent predictor of mortality (n=64, AUC = 0.69, p=0.017), but not fasting glucose (n=64, AUC =0.60, p=0.32) or HbA1c (n=40, AUC=0.58, p =0.46), respectively. With respect to clinical variables, a combination of BMI and Age was predictive of mortality (AUC = 0.77, p=0.004). Interestingly, when 1,5-AG was added to BMI and Age, the AUC increased to 0.94 (p <0.0001). When fasting glucose was added to BMI and Age the AUC was 0.79 (p =0.001). A cox regression analysis demonstrated that 1,5-AG < 10 ug/mL was associated with an odds ratio of 0.44 (95% CI =0.11-1.85) for mortality. Conclusions: This analysis demonstrated that 1,5-AG is a novel and independent predictor of COVID-19 mortality. 1,5-AG may provide important and unique information in the COVID-19 clinical setting. An algorithm of BMI, Age, and 1,5-AG can be used clinically to predict mortality. These findings warrant further investigation in larger studies specific for diabetic and non-diabetic populations.