Hyperglycemia may increase risk of in-hospital infection, AKI, and stroke in hospital inpatients: Study

The study was published online in The Journal of Clinical Endocrinology & Metabolism on January 27, 2024.

Previous studies have shown that hyperglycemia in hospital inpatients without pre-existing diabetes is associated with increased mortality. However, there seems no clarity on the independent contribution of hyperglycemia to healthcare-associated infection, stroke, and acute kidney injury. Therefore, Rahul D. Barmanray, The University of Melbourne, Melbourne, Australia, and colleagues aimed to investigate the relationship between hyperglycemia and adverse clinical outcomes in hospital for patients with and without diabetes.

For this purpose, the researcher performed a 26-week (October 2019 – March 2020) prospective cohort study, Diabetes IN-hospital: Glucose and Outcomes (DINGO).

Primary stratification was by hyperglycemia, defined as ≥2 random capillary blood glucose (BG) measurements ≥11.1 mmol/L (≥200 mg/dL). To allow interrogation of causality, propensity weighting for nine clinical characteristics was performed. To maintain the positivity assumption, patients with HbA1c > 12.0% were excluded and pre-hospital treatment was not adjusted for.

The patients with admissions with at least two capillary glucose values and length of stay >24 hours were eligible, with half randomly sampled. Of 2,558 included admissions, 1,147 (45%) experienced hyperglycemia in hospital.

Outcome measures included mortality, stroke, healthcare-associated infection, and acute kidney injury.

The researchers revealed that following propensity-weighting and adjustment, hyperglycemia in the hospital independently of nine covariables contributes to an increased risk of in-hospital HAI (11.3% versus 7.1%, adjusted odds ratio [aOR] 1.03), AKI (10.5% versus 4.2%, aOR 1.07), and stroke 0.9% versus 0.1%, aOR 1.05).

"In hospital inpatients (HbA1c ≤ 12.0%), regardless of diabetes status and pre-hospital glycaemia, hyperglycemia raises the risk of in-hospital HAI, AKI, and stroke compared with those not experiencing hyperglycemia," the researchers concluded.

Reference:

Barmanray, R. D., Kyi, M., Worth, L. J., Colman, P. G., Churilov, L., Fazio, T. N., Rayman, G., Gonzalez, V., Hall, C., & Fourlanos, S. Hyperglycemia in hospital: An independent marker of infection, acute kidney injury & stroke for hospital inpatients. The Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/clinem/dgae051