Hyperglycemia and glucose variability are associated with worse survival in mechanically ventilated COVID-19 patients: the prospective Maastricht Intensive Care Covid Cohort.

"Declarations Ethical approvalEthical approval was obtained from the medical ethics committee (METC 2020–1565/300 523) of Maastricht UMC+. The study was performed in accordance with the General Data Protection Regulation (GDPR) act and the national data privacy laws. Patient data were collected according to good clinical practice and in accordance with relevant guidelines and regulations. Informed consent was obtained from all participants included in the study. Consent for publicationNot applicable. Competing interestsThe authors declare no competing interests. Competing interests The authors declare no competing interests."

"Funding The authors have not declared a specific grant for this research from any funding agency in. the public, commercial or not-for-profit sectors."

"The Maastricht Intensive Care COVID (MaastrICCht) cohort study design has been described more extensively elsewhere [–]. Briefly, this prospective cohort study included patients admitted to the Intensive Care of the Maastricht University Medical Centre+ (Maastricht UMC+), a tertiary care university teaching hospital in the southern part of the Netherlands. The local institutional review board (Medisch Ethische Toetsingscomissie (METC) 2020 − 1565/ 300,523) of the Maastricht UMC + approved the study, which was performed based on the declaration of Helsinki. Despite the challenging times of the COVID-19 pandemic [], all patients and their families provided complete informed consent for the utilization of the collected data and storage of leftover serum samples for critical COVID-19 research purposes. The study has been registered in the Netherlands Trial Register (registration number NL8613). This study included all participants with respiratory insufficiency requiring mechanical ventilation and at least one positive PCR test for SARS-CoV-2 and/or a chest CT scan strongly suggestive of SARS-CoV-2 infection, based on a COVID-19 Reporting and Data System (CORADS)-score of 4–5 []. Participants were followed from the moment of intubation until the primary outcome (death during ICU admission or discharge from the ICU). Clinical, physiological, and laboratory variables were collected using a predefined study protocol described elsewhere []. For the present study, participants were included based on the day of the start of mechanical ventilation/intubation in wave 1 from March 15th, 2020, until July 2020, and in wave 2 from October 2020 until March 23th, 2021. Thus data from the first and second waves were included. During the first wave, patients were intubated according to early Dutch intensive care guidelines, as there were concerns about the virus spread using other modes of oxygen or ventilator support []. However, since accumulating evidence shows its safety [] high-flow nasal oxygen was applied in the second wave onwards. As we aimed to investigate the development of variables over time, like in previous reports [, ], we included intubated and mechanically ventilated patients and set intubation as day one. This makes patients at inclusion to be assumed at similar time-points of disease and severity during their COVID-19 disease, i.e., an inception cohort. In addition, this allows us to take all observations into account over time, also if a patient is transported after intubation from another ICU, facilitating the investigation of the development of variables over time [, , ]."