Inpatient hyperglycaemia, and impact on morbidity, mortality and re-hospitalisation rates

Farrugia, Yvette; Mangion, Jessica; Fava, Marie-Claire; Vella, Christine; Gruppetta, Mark

doi:10.7861/clinmed.2022-0112

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…In addition, Farrugia et al. indicated admission glucose remained a significant predictor of 1-year readmission ( 18 ). Zhou et al.…”

Section: Discussionmentioning

confidence: 99%

The correlation between admission hyperglycemia and 30-day readmission after hip fracture surgery in geriatric patients: a propensity score-matched study

Tang,

Ni,

Yao

et al. 2024

Front. Endocrinol.

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PurposeThis study aimed to investigate the association between admission hyperglycemia and 30-day readmission after hip fracture surgery in geriatric patients.MethodsThis retrospective study included 1253 geriatric hip fracture patients. Patients were categorized into normoglycemia(<6.10 mmol/L) and hyperglycemia groups(≥6.10 mmol/L) based on admission blood glucose. We performed multivariable logistic regression analyses and propensity score matching (PSM) to estimate adjusted odds ratios and 95% confidence intervals for 30-day readmission, controlling for potential confounding factors. An analysis of the dose-dependent association between admission blood glucose and the probability of 30-day readmission was performed. Additional subgroup analysis was conducted to examine the impact of other factors on the relationship between admission blood glucose and 30-day readmission.ResultsPatients with hyperglycemia had higher 30-day readmission rates than normoglycemic patients before (19.1% vs 9.7%, p<0.001) and after PSM (18.1% vs 12.3%, p=0.035). Admission hyperglycemia was an independent predictor of increased 30-day readmission risk, with an adjusted odds ratio of 1.57 (95% CI 1.08-2.29, p=0.019) after multivariable regression and 1.57 (95% CI 1.03-2.39, p=0.036) after PSM. A dose-response relationship was observed between higher glucose levels and increased readmission risk.ConclusionAdmission hyperglycemia is an independent risk factor for 30-day readmission after hip fracture surgery in the elderly. Routine glucose testing upon admission and perioperative glycemic control may help reduce short-term readmissions in this vulnerable population.

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“…In addition, Farrugia et al. indicated admission glucose remained a significant predictor of 1-year readmission ( 18 ). Zhou et al.…”

Section: Discussionmentioning

confidence: 99%

The correlation between admission hyperglycemia and 30-day readmission after hip fracture surgery in geriatric patients: a propensity score-matched study

Tang,

Ni,

Yao

et al. 2024

Front. Endocrinol.

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“…Stress hyperglycemia (SH) is a frequent finding in patients assigned to emergency departments or ICUs 1–3 . It correlates with higher in‐hospital morbidity, length of stay, and mortality 4 .…”

Section: Introductionmentioning

confidence: 99%

“…Stress hyperglycemia (SH) is a frequent finding in patients assigned to emergency departments or ICUs. 1 , 2 , 3 It correlates with higher in‐hospital morbidity, length of stay, and mortality. 4 Poorer outcomes associated with SH have been reported for myocardial infarction and stroke but also in viral infections like COVID‐19.…”

Section: Introductionmentioning

confidence: 99%

Association of preclinical blood glucose with hospitalization rate and in‐hospital mortality: A single‐center retrospective cohort study

Kloock,

Skudelny,

Kranke

et al. 2024

JACEP Open

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ObjectiveCritical illness is often accompanied by elevated blood glucose, which generally correlates with increased morbidity and mortality. Prehospital blood glucose (PBG) level might be a useful and easy‐to‐perform tool for risk assessment in emergency medicine. This retrospective single‐center cohort study was designed to analyze the association of prehospital glucose measurements with hospitalization rate and in‐hospital mortality.MethodsRecords of 970 patients admitted to a university hospital by an emergency physician were analyzed. Patients with a PBG ≥140 mg/dL (G1, n = 394, equal to 7.8 mmol/L) were compared with patients with a PBG <140 mg/dL (G2, n = 576). Multivariable logistic regression models were used to correct for age, prediagnosed diabetes, and sex.ResultsFive hundred thirty‐four patients (55%) were hospitalized. In comparison to normoglycemic patients, hyperglycemic patients were more likely to be hospitalized with an adjusted odds ratio (OR) of 1.48 (95% confidence interval [CI] 1.11–1.97), more likely to be admitted to the intensive care unit (ICU) with an adjusted OR of 1.74 (95% CI 1.31–2.31) and more likely to die in the hospital with an adjusted OR of 1.84 (95% CI 0.96–3.53). Hospitalized hyperglycemic patients had a median length of stay of 6.0 days (interquartile range [IQR] 8.0) compared to 3.0 days (IQR 6.0) in the normoglycemic group (P < 0.001). In the subgroup analysis of cases without known diabetes, patients with PBG ≥140 mg/dL were more likely to be hospitalized with an adjusted OR of 1.49 (95% CI 1.10–2.03) and more likely to be admitted to ICU/intermediate care with an adjusted OR of 1.80 (95% CI 1.32–2.45), compared to normoglycemic patients.ConclusionElevated PBG ≥140 mg/dL was associated with a higher hospitalization risk, a longer length of stay, and a higher mortality risk and may therefore be included in risk assessment scores.

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“…These papers dovetail excellently with the topic of this month's CME papers, on the topic of geriatric medicine, which includes papers on frailty in acute presentations and pain management in older patients.A paper from Farrugia and colleagues in Malta investigates the often-overlooked issue of uncontrolled plasma glucose in patients admitted to hospital. 3 Whether hyperglycaemia itself leads to a poorer outcome or is merely an indicator of a more severe illness is investigated by correlation with mortality and course of hospitalisation, but also analysed in relation to seasonal variation. The results indicate that serum glucose may be an important prognostic marker and may indicate a more severe illness, independent of diabetic history.…”

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confidence: 99%

Impacting outcomes in acute care

Emmanuel¹

2022

Clinical Medicine

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The assessment of acutely presenting patients is the subject of a few articles in this edition of ClinMed. An exploratory study by Kellett et al investigated the changes in patients' health condition, as reflected by mental status, mobility and vital signs, occurring between admission and discharge dates. 1 The study from a hospital in sub-Saharan Africa identifies that as many as four out of 10 patients experience a deterioration between admission and discharge; the question of whether this prevalence is matched in hospitals in the well-resourced world warrants further study.There are approximately 650,000 patients admitted annually with hip fracture, and physician teams are often involved with their care, with the formation of so-called 'orthogeriatric' teams. Han and colleagues report on 10-year trends both in the factors associated with elapsed time to surgery and in outcomes from surgery. 2 The results presented are crucial to developing services and to decisionmaking in the scheduling of hip fracture surgical cases. These papers dovetail excellently with the topic of this month's CME papers, on the topic of geriatric medicine, which includes papers on frailty in acute presentations and pain management in older patients.A paper from Farrugia and colleagues in Malta investigates the often-overlooked issue of uncontrolled plasma glucose in patients admitted to hospital. 3 Whether hyperglycaemia itself leads to a poorer outcome or is merely an indicator of a more severe illness is investigated by correlation with mortality and course of hospitalisation, but also analysed in relation to seasonal variation. The results indicate that serum glucose may be an important prognostic marker and may indicate a more severe illness, independent of diabetic history. Recommendations about monitoring of glycated haemoglobin at admission in cases of new-onset hyperglycaemia are worthy of prospective study.Another important manuscript in this edition, from Whyte et al, is a summary of the revised guideline from the Resuscitation Council UK on the emergency management of anaphylaxis. 4 There are notable updates on recognition, management, observation and follow-up of patients with anaphylaxis. There are updates on the respective roles of corticosteroids and antihistamines, and important summaries of changes to the recommended duration of observation for patients who have experienced anaphylaxis. The paper is strongly practical and, as well as being an asset to individual practitioners and those preparing for exams, it includes algorithms and figures from the Resuscitation

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Inpatient hyperglycaemia, and impact on morbidity, mortality and re-hospitalisation rates

Cited by 5 publications

References 30 publications

The correlation between admission hyperglycemia and 30-day readmission after hip fracture surgery in geriatric patients: a propensity score-matched study

The correlation between admission hyperglycemia and 30-day readmission after hip fracture surgery in geriatric patients: a propensity score-matched study

Association of preclinical blood glucose with hospitalization rate and in‐hospital mortality: A single‐center retrospective cohort study

Impacting outcomes in acute care

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