An Independent Marker of Infection, Acute Kidney Injury, and Stroke for Hospital Inpatients
Rahul D Barmanray, Mervyn Kyi, Leon J Worth, Peter G Colman, Leonid Churilov, Timothy N Fazio, Gerry Rayman, Vicky Gonzalez, Candice Hall, Spiros Fourlanos
The Journal of Clinical Endocrinology & Metabolism, Volume 109, Issue 11, November 2024, Pages e2048–e2056
https://doi.org/10.1210/clinem/dgae051
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.
To investigate the relationship between hyperglycemia and adverse clinical outcomes in hospital for patients with and without diabetes.
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.
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).
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.
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