RT Journal Article
T1 Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain
A1 Mayneris-Perxachs, Jordi
A1 Francesca Russo, Maria
A1 Ramos, Rafel
A1 de Hollanda, Ana
A1 Armengou Arxe, Arola
A1 Rottoli, Matteo
A1 Arnoriaga-Rodriguez, Maria
A1 Comas-Cufi, Marc
A1 Bartoletti, Michele
A1 Verrastro, Ornella
A1 Gudiol, Carlota
A1 Fages, Ester
A1 Gimenez, Marga
A1 de Genover Gil, Ariadna
A1 Bernante, Paolo
A1 Tinahones, Francisco
A1 Carratala, Jordi
A1 Pagotto, Uberto
A1 Hernandez-Aguado, Ildefonso
A1 Fernandez-Aranda, Fernando
A1 Meira, Fernanda
A1 Castro Guardiola, Antoni
A1 Mingrone, Geltrude
A1 Manuel Fernandez-Real, Jose
A1 Obesity-T2DM Covid19 Study Grp, 
K1 COVID-19
K1 hemoglobin
K1 hyperglycemia
K1 obesity
K1 epidemiology
K1 mortality
K1 machine learning
K1 Sars-cov-2
K1 Mortality
K1 Selection
K1 Admission
K1 Outcomes
AB 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.
PB Frontiers media sa
SN 1664-2392
YR 2021
FD 2021-11-02
LK https://hdl.handle.net/10668/26920
UL https://hdl.handle.net/10668/26920
LA en
DS RISalud
RD Apr 8, 2025