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. 2024 Oct 15;109(11):e2048-e2056.
doi: 10.1210/clinem/dgae051.

Hyperglycemia in Hospital: An Independent Marker of Infection, Acute Kidney Injury, and Stroke for Hospital Inpatients

Rahul D Barmanray  1   2   3 , Mervyn Kyi  1   2   3 , Leon J Worth  4   5 , Peter G Colman  1   2 , Leonid Churilov  2   3 , Timothy N Fazio  6 , Gerry Rayman  7 , Vicky Gonzalez  1 , Candice Hall  1 , Spiros Fourlanos  1   2   3
Affiliations

Hyperglycemia in Hospital: An Independent Marker of Infection, Acute Kidney Injury, and Stroke for Hospital Inpatients

Rahul D Barmanray et al. J Clin Endocrinol Metab. .

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.

Keywords: acute kidney injury; diabetes; glucometrics; health care–associated infection; hyperglycemia; in-hospital; outcomes; stroke.

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