Frontiers in Endocrinology (Nov 2021)

Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain

  • Jordi Mayneris-Perxachs,
  • Jordi Mayneris-Perxachs,
  • Jordi Mayneris-Perxachs,
  • Maria Francesca Russo,
  • Rafel Ramos,
  • Rafel Ramos,
  • Rafel Ramos,
  • Ana de Hollanda,
  • Ana de Hollanda,
  • Arola Armengou Arxé,
  • Matteo Rottoli,
  • Matteo Rottoli,
  • María Arnoriaga-Rodríguez,
  • María Arnoriaga-Rodríguez,
  • María Arnoriaga-Rodríguez,
  • María Arnoriaga-Rodríguez,
  • Marc Comas-Cufí,
  • Michele Bartoletti,
  • Ornella Verrastro,
  • Carlota Gudiol,
  • Carlota Gudiol,
  • Carlota Gudiol,
  • Carlota Gudiol,
  • Carlota Gudiol,
  • Ester Fages,
  • Ester Fages,
  • Marga Giménez,
  • Marga Giménez,
  • Marga Giménez,
  • Ariadna de Genover Gil,
  • Paolo Bernante,
  • Paolo Bernante,
  • Francisco Tinahones,
  • Francisco Tinahones,
  • Jordi Carratalà,
  • Jordi Carratalà,
  • Jordi Carratalà,
  • Jordi Carratalà,
  • Uberto Pagotto,
  • Ildefonso Hernández-Aguado,
  • Ildefonso Hernández-Aguado,
  • Fernando Fernández-Aranda,
  • Fernando Fernández-Aranda,
  • Fernando Fernández-Aranda,
  • Fernando Fernández-Aranda,
  • Fernanda Meira,
  • Fernanda Meira,
  • Fernanda Meira,
  • Antoni Castro Guardiola,
  • Geltrude Mingrone,
  • Geltrude Mingrone,
  • José Manuel Fernández-Real,
  • José Manuel Fernández-Real,
  • José Manuel Fernández-Real,
  • José Manuel Fernández-Real,
  • Obesity-T2DM Covid19 Study Group,
  • Mariona Reixach Fumaña,
  • Susana Jimenez-Murcia,
  • Mikel Eatxandi,
  • Alexander Rombauts,
  • Gabriela Abelenda-Alonso,
  • Caterina Guidone,
  • Danila Anello,
  • Giulia Giannetti,
  • Emilio Ortega,
  • Ignacio Conget,
  • Clara Viñals,
  • Carmen Hernández-Aguado,
  • Josep-Maria Sirvent,
  • Ramon Orriols,
  • Mercé Fernández-Balsells,
  • Wifredo Ricart

DOI
https://doi.org/10.3389/fendo.2021.741248
Journal volume & issue
Vol. 12

Abstract

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BackgroundHyperglycemia and obesity are associated with a worse prognosis in subjects with COVID-19 independently. Their interaction as well as the potential modulating effects of additional confounding factors is poorly known. Therefore, we aimed to identify and evaluate confounding factors affecting the prognostic value of obesity and hyperglycemia in relation to mortality and admission to the intensive care unit (ICU) due to COVID-19.MethodsConsecutive patients admitted in two Hospitals from Italy (Bologna and Rome) and three from Spain (Barcelona and Girona) as well as subjects from Primary Health Care centers. Mortality from COVID-19 and risk for ICU admission were evaluated using logistic regression analyses and machine learning (ML) algorithms.ResultsAs expected, among 3,065 consecutive patients, both obesity and hyperglycemia were independent predictors of ICU admission. A ML variable selection strategy confirmed these results and identified hyperglycemia, blood hemoglobin and serum bilirubin associated with increased mortality risk. In subjects with blood hemoglobin levels above the median, hyperglycemic and morbidly obese subjects had increased mortality risk than normoglycemic individuals or non-obese subjects. However, no differences were observed among individuals with hemoglobin levels below the median. This was particularly evident in men: those with severe hyperglycemia and hemoglobin concentrations above the median had 30 times increased mortality risk compared with men without hyperglycemia. Importantly, the protective effect of female sex was lost in subjects with increased hemoglobin levels.ConclusionsBlood hemoglobin substantially modulates the influence of hyperglycemia on increased mortality risk in patients with COVID-19. Monitoring hemoglobin concentrations seem of utmost importance in the clinical settings to help clinicians in the identification of patients at increased death risk.

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