Hyperglycemia in Hospital: An Independent Marker of Infection, Acute Kidney Injury, and Stroke for Hospital Inpatients
- Author(s)
- Barmanray, RD; Kyi, M; Worth, LJ; Colman, PG; Churilov, L; Fazio, TN; Rayman, G; Gonzalez, V; Hall, C; Fourlanos, S;
- Details
- Publication Year 2024-10-15,Volume 109,Issue #11,Page e2048-e2056
- Journal Title
- Journal of Clinical Endocrinology and Metabolism
- Publication Type
- Research article
- Abstract
- CONTEXT: Hyperglycemia in hospital inpatients without pre-existing diabetes is associated with increased mortality. However, the independent contribution of hyperglycemia to health care-associated infection (HAI), acute kidney injury (AKI), and stroke is unclear. OBJECTIVE: To investigate the relationship between hyperglycemia and adverse clinical outcomes in hospital for patients with and without diabetes. METHODS: Diabetes IN-hospital: Glucose and Outcomes (DINGO) was a 26-week (October 2019-March 2020) prospective cohort study. Clinical and glucose data were collected up to the 14th day of admission. Primary stratification was by hyperglycemia, defined as ≥2 random capillary blood glucose (BG) measurements ≥11.1 mmol/L (≥200 mg/dL). Propensity weighting for 9 clinical characteristics was performed to allow interrogation of causality. To maintain the positivity assumption, patients with HbA1c >12.0% were excluded and prehospital treatment not adjusted for. The setting was the Royal Melbourne Hospital, a quaternary referral hospital in Melbourne, Australia. Admissions with at least 2 capillary glucose values and length of stay >24 hours were eligible, with half randomly sampled. Outcome measures were HAI, AKI, stroke, and mortality. RESULTS: Of 2558 included admissions, 1147 (45%) experienced hyperglycemia in hospital. Following propensity-weighting and adjustment, hyperglycemia in hospital was found to, independently of 9 covariables, contribute an increased risk of in-hospital HAI (130 [11.3%] vs 100 [7.1%], adjusted odds ratio [aOR] 1.03, 95% CI 1.01-1.05, P = .003), AKI (120 [10.5%] vs 59 [4.2%], aOR 1.07, 95% CI 1.05-1.09, P < .001), and stroke (10 [0.9%] vs 1 [0.1%], aOR 1.05, 95% CI 1.04-1.06, P < .001). CONCLUSION: In hospital inpatients (HbA1c ≤12.0%), irrespective of diabetes status and prehospital glycemia, hyperglycemia increases the risk of in-hospital HAI, AKI, and stroke compared with those not experiencing hyperglycemia.
- Publisher
- Oxford University Press
- Keywords
- Humans; *Hyperglycemia/epidemiology/blood/complications; Male; Female; *Acute Kidney Injury/epidemiology/blood/etiology/diagnosis; *Stroke/epidemiology/blood; Aged; Middle Aged; Prospective Studies; *Hospitalization/statistics & numerical data; Blood Glucose/analysis/metabolism; Cross Infection/epidemiology/blood; Inpatients/statistics & numerical data; Biomarkers/blood; Aged, 80 and over; Risk Factors; Hospital Mortality; Australia/epidemiology; Prognosis; acute kidney injury; diabetes; glucometrics; health care–associated infection; hyperglycemia; in-hospital; outcomes; stroke
- Department(s)
- Infectious Diseases
- Publisher's Version
- https://doi.org/10.1210/clinem/dgae051
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-10-22 06:25:42
Last Modified: 2024-10-22 06:25:55