CHARACTERISTICS OF COVID-19 PATIENTS WITH HYPERGLYCAEMIC EMERGENCY AND MORTALITY OUTCOMES: SINGLE CENTRE EXPERIENCE IN PAHANG

ABSTRACT

Introduction Individuals with diabetes have similar risk of contracting COVID-19 infection compared to those without diabetes. However, COVID-19 patients with diabetes are at a higher risk for severe outcomes and death. The occurrence of hyperglycaemic emergency and diabetic ketoacidosis (DKA) may worsen the outcomes of COVID-19 infection. This study will determine the characteristics of COVID-19 patients admitted with hyperglycaemic emergency and mortality outcomes in Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang. Methodology All electronic records of COVID-19 patients admitted from March 2021 until March 2022 were reviewed for occurrence of hyperglycaemic emergency. Data regarding demographics, clinical presentation, laboratory investigations and clinical outcomes were collected. Further analysis with patients subcategorised into 2 timelines March-December 2021 (group 1) and January-March 2022 (group 2) reflecting two surges of COVID-19 admission to the hospital was done. Results Twenty-four COVID-19 patients with hyperglycaemic emergency [mean age 56.7 (SD 15.6) years, 54.2% female, 79.2% Malay ethnicity, 95.8% type 2 diabetes mellitus, 54.2% unvaccinated, 70.8% category 5 infection] were analysed. Majority of patients had DKA at 79.2% [mean pH 7.16(SD 0.12), mean HCO3 10.80 (SD 3.07), mean glucose at diagnosis 25.3 (SD 11.0) mmol/L]. The mean length of hospitalisation was 11.42 (SD 7.4) days and mortality rate was 63.2%. Nine DKA cases were detected in group 1 compared to 10 cases during the shorter timeline in group 2. All patients had resolved DKA but the majority succumbed later due to complications of COVID-19 infection. Mortality rates in both groups were 66.7%(n=6) and 60%(n=6), respectively. Conclusion Despite high occurrence of uncontrolled diabetes during COVID-19 infection in this cohort, only a small proportion had hyperglycaemic emergency. In both timeline of hospitalisation surge, COVID-19 patients with concomitant hyperglycaemic emergency had poorer prognosis.