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

Autor:	Barmanray RD; Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Melbourne 3000, Australia.; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne 3000, Australia.; Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne 3000, Australia., Kyi M; Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Melbourne 3000, Australia.; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne 3000, Australia.; Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne 3000, Australia., Worth LJ; National Centre for Infections in Cancer (NCIC), Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne 3000, Australia.; Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Doherty Institute, Melbourne 3000, Australia., Colman PG; Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Melbourne 3000, Australia.; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne 3000, Australia., Churilov L; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne 3000, Australia.; Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne 3000, Australia., Fazio TN; Health Intelligence Unit, The Royal Melbourne Hospital, Melbourne 3000, Australia., Rayman G; Department of Diabetes and Endocrinology, Ipswich General Hospital NHS Trust, Ipswich IP4 5PD, UK., Gonzalez V; Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Melbourne 3000, Australia., Hall C; Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Melbourne 3000, Australia., Fourlanos S; Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Melbourne 3000, Australia.; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne 3000, Australia.; Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne 3000, Australia.
Jazyk:	angličtina
Zdroj:	The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2024 Oct 15; Vol. 109 (11), pp. e2048-e2056.
DOI:	10.1210/clinem/dgae051
Abstrakt:	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. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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