Inpatient hyperglycemia, regardless of diabetes status, tied to risk of AKI, stroke, and infections: Study

“Hyperglycemia in-hospital raises the risk of healthcare-associated infection (HAI), stroke, and acute kidney injury (AKI),” the researchers reported. “Patients who experienced hyperglycemia without a prior diabetes diagnosis had a greater risk of mortality.”

Hyperglycemia in hospital inpatients without pre-existing diabetes is linked with increased mortality. However, there is no clarity on the independent contribution of hyperglycemia to acute kidney injury, stroke, and healthcare–associated infection. 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 researchers performed Diabetes IN-hospital: Glucose and Outcomes (DINGO), a 26-week (October 2019-March 2020) prospective cohort study. Glucose and clinical 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).

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 prehospital treatment was not adjusted for.

The study was set in the Royal Melbourne Hospital, a quaternary referral hospital in Melbourne, Australia. Admissions with at least 2 capillary glucose values and a length of stay >24 hours were eligible, with half randomly sampled. Outcome measures were AKI, HAI, stroke, and mortality.

The study led to the following findings:

• 45% experienced hyperglycemia in hospital of 2558 included admissions.
• Following propensity-weighting and adjustment, hyperglycemia in hospital was found to, independently of 9 covariables, contribute to an increased risk of in-hospital HAI (11.3% vs 7.1%, adjusted odds ratio [aOR] 1.03), AKI (10.5% vs 4.2%, aOR 1.07), and stroke (0.9% vs 0.1%, aOR 1.05).

“In hospital inpatients (HbA1c ≤12.0%), regardless of diabetes status and prehospital glycemia, 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, and Stroke for Hospital Inpatients. The Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/clinem/dgae051