Retrospective observational study of the association of peak blood glucose during the second 24 hours of admission with hospital-acquired complications in non-critical care admissions to a tertiary referral teaching hospital

Barbara Depczynski; Getiye Dejenu Kibret; Andrew Georgiou; Sue Mei Lau

doi:10.1136/bmjopen-2024-089652

Retrospective observational study of the association of peak blood glucose during the second 24 hours of admission with hospital-acquired complications in non-critical care admissions to a tertiary referral teaching hospital

Barbara Depczynski, Getiye Dejenu Kibret, Andrew Georgiou, Sue Mei Lau

Australian Institute of Health Innovation

Research output: Contribution to journal › Article › peer-review

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Abstract

Introduction: Stress hyperglycaemia at hospital presentation is associated with poorer outcomes. Less is known about the risk of poorer outcomes according to achieved glycaemia early in the admission.

Research design/methods: This was a retrospective observational study of patients admitted to non-critical care wards. The aim was to determine the relationship between the day 2 peak blood glucose and the occurrence of hospital-acquired complications (HACs) or in-hospital mortality. A Cox proportional hazards model, adjusted for relevant covariates, was used to evaluate the impact of day 2 peak glucose on HACs and in-hospital mortality, and we identified peak glucose thresholds correlating with an increase in risk.

Results: For the whole cohort, day 2 peak glucose was associated with an increased risk of any HAC, aHR=1.06, 95% CI: 1.04, 1.07; but not in-hospital mortality, aHR=0.98, 95% CI: 0.94, 1.01. The risk of HAC infection increased by 4.6% for every mmol/L rise in day 2 peak glucose (aHR=1.05, 95% CI: 1.02, 1.08) in the diabetes cohort compared with 5.5% (aHR=1.06, 95% CI: 1.00, 1.11) in the non-diabetes cohort. The risk of HAC cardiac in the diabetes cohort increased by 5.3% (aHR=1.05, CI: 1.01, 1.10) per mmol/L increase in day 2 peak glucose; no association was found in the non-diabetes cohort (aHR=1.03, 95% CI: 0.94, 1.13). The risk for in-hospital mortality was associated with day 2 peak glucose, aHR=1.11, 95% CI: 1.03, 1.20, in patients without diabetes, but not in patients with diabetes, aHR=1.00, 95% CI: 0.95, 1.06. There was an increase in the risk of HAC once day 2 peak blood glucose exceeded 19.0 mmol/L (whole cohort), with thresholds of 13.6 mmol/L in the non-diabetes group and 19.5 mmol/L in the diabetes group.

Conclusion: The peak glucose on day 2 was a predictor of HAC in the entire cohort and in-hospital mortality in patients without diabetes.

Original language	English
Article number	e089652
Pages (from-to)	1-9
Number of pages	9
Journal	BMJ Open
Volume	15
Issue number	1
DOIs	https://doi.org/10.1136/bmjopen-2024-089652
Publication status	Published - 14 Jan 2025

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Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

Diabetes & Endocrinology
General diabetes
Hospitalization

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Establishing a digital health foundation for outcomes-based diagnostic excellence, safety and value
Georgiou, A. (Primary Chief Investigator), Center, J. (Chief Investigator), Westbrook, J. (Chief Investigator), Rawlinson, W. D. (Chief Investigator), Curtis, K. (Chief Investigator), Post, J. (Chief Investigator), Horvath, A. R. (Chief Investigator), Hillman, K. (Chief Investigator), Amin, J. (Chief Investigator), Endre, Z. (Chief Investigator), Mei Lau, S. (Associate Investigator), Depczynski, B. (Associate Investigator), Weei Angela Sheu, Y. (Associate Investigator), Bliuc, D. (Associate Investigator), Tran , T. (Associate Investigator), Eigenstetter, A. (Associate Investigator), Scowen, C. (Associate Investigator), Mackie , J. (Associate Investigator), Mumford, V. (Associate Investigator) & Lee, S. (Associate Investigator)
1/02/22 → 31/01/27
Project: Research

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Depczynski, B., Kibret, G. D., Georgiou, A., & Lau, S. M. (2025). Retrospective observational study of the association of peak blood glucose during the second 24 hours of admission with hospital-acquired complications in non-critical care admissions to a tertiary referral teaching hospital. BMJ Open, 15(1), 1-9. Article e089652. https://doi.org/10.1136/bmjopen-2024-089652

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title = "Retrospective observational study of the association of peak blood glucose during the second 24 hours of admission with hospital-acquired complications in non-critical care admissions to a tertiary referral teaching hospital",

abstract = "Introduction: Stress hyperglycaemia at hospital presentation is associated with poorer outcomes. Less is known about the risk of poorer outcomes according to achieved glycaemia early in the admission.Research design/methods: This was a retrospective observational study of patients admitted to non-critical care wards. The aim was to determine the relationship between the day 2 peak blood glucose and the occurrence of hospital-acquired complications (HACs) or in-hospital mortality. A Cox proportional hazards model, adjusted for relevant covariates, was used to evaluate the impact of day 2 peak glucose on HACs and in-hospital mortality, and we identified peak glucose thresholds correlating with an increase in risk.Results: For the whole cohort, day 2 peak glucose was associated with an increased risk of any HAC, aHR=1.06, 95\% CI: 1.04, 1.07; but not in-hospital mortality, aHR=0.98, 95\% CI: 0.94, 1.01. The risk of HAC infection increased by 4.6\% for every mmol/L rise in day 2 peak glucose (aHR=1.05, 95\% CI: 1.02, 1.08) in the diabetes cohort compared with 5.5\% (aHR=1.06, 95\% CI: 1.00, 1.11) in the non-diabetes cohort. The risk of HAC cardiac in the diabetes cohort increased by 5.3\% (aHR=1.05, CI: 1.01, 1.10) per mmol/L increase in day 2 peak glucose; no association was found in the non-diabetes cohort (aHR=1.03, 95\% CI: 0.94, 1.13). The risk for in-hospital mortality was associated with day 2 peak glucose, aHR=1.11, 95\% CI: 1.03, 1.20, in patients without diabetes, but not in patients with diabetes, aHR=1.00, 95\% CI: 0.95, 1.06. There was an increase in the risk of HAC once day 2 peak blood glucose exceeded 19.0 mmol/L (whole cohort), with thresholds of 13.6 mmol/L in the non-diabetes group and 19.5 mmol/L in the diabetes group.Conclusion: The peak glucose on day 2 was a predictor of HAC in the entire cohort and in-hospital mortality in patients without diabetes.",

keywords = "Diabetes \& Endocrinology, General diabetes, Hospitalization",

author = "Barbara Depczynski and Kibret, \{Getiye Dejenu\} and Andrew Georgiou and Lau, \{Sue Mei\}",

note = "Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2025",

month = jan,

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doi = "10.1136/bmjopen-2024-089652",

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Depczynski, B, Kibret, GD , Georgiou, A & Lau, SM 2025, 'Retrospective observational study of the association of peak blood glucose during the second 24 hours of admission with hospital-acquired complications in non-critical care admissions to a tertiary referral teaching hospital', BMJ Open, vol. 15, no. 1, e089652, pp. 1-9. https://doi.org/10.1136/bmjopen-2024-089652

Retrospective observational study of the association of peak blood glucose during the second 24 hours of admission with hospital-acquired complications in non-critical care admissions to a tertiary referral teaching hospital. / Depczynski, Barbara; Kibret, Getiye Dejenu ; Georgiou, Andrew et al.
In: BMJ Open, Vol. 15, No. 1, e089652, 14.01.2025, p. 1-9.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Retrospective observational study of the association of peak blood glucose during the second 24 hours of admission with hospital-acquired complications in non-critical care admissions to a tertiary referral teaching hospital

AU - Depczynski, Barbara

AU - Kibret, Getiye Dejenu

AU - Georgiou, Andrew

AU - Lau, Sue Mei

N1 - Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2025/1/14

Y1 - 2025/1/14

N2 - Introduction: Stress hyperglycaemia at hospital presentation is associated with poorer outcomes. Less is known about the risk of poorer outcomes according to achieved glycaemia early in the admission.Research design/methods: This was a retrospective observational study of patients admitted to non-critical care wards. The aim was to determine the relationship between the day 2 peak blood glucose and the occurrence of hospital-acquired complications (HACs) or in-hospital mortality. A Cox proportional hazards model, adjusted for relevant covariates, was used to evaluate the impact of day 2 peak glucose on HACs and in-hospital mortality, and we identified peak glucose thresholds correlating with an increase in risk.Results: For the whole cohort, day 2 peak glucose was associated with an increased risk of any HAC, aHR=1.06, 95% CI: 1.04, 1.07; but not in-hospital mortality, aHR=0.98, 95% CI: 0.94, 1.01. The risk of HAC infection increased by 4.6% for every mmol/L rise in day 2 peak glucose (aHR=1.05, 95% CI: 1.02, 1.08) in the diabetes cohort compared with 5.5% (aHR=1.06, 95% CI: 1.00, 1.11) in the non-diabetes cohort. The risk of HAC cardiac in the diabetes cohort increased by 5.3% (aHR=1.05, CI: 1.01, 1.10) per mmol/L increase in day 2 peak glucose; no association was found in the non-diabetes cohort (aHR=1.03, 95% CI: 0.94, 1.13). The risk for in-hospital mortality was associated with day 2 peak glucose, aHR=1.11, 95% CI: 1.03, 1.20, in patients without diabetes, but not in patients with diabetes, aHR=1.00, 95% CI: 0.95, 1.06. There was an increase in the risk of HAC once day 2 peak blood glucose exceeded 19.0 mmol/L (whole cohort), with thresholds of 13.6 mmol/L in the non-diabetes group and 19.5 mmol/L in the diabetes group.Conclusion: The peak glucose on day 2 was a predictor of HAC in the entire cohort and in-hospital mortality in patients without diabetes.

AB - Introduction: Stress hyperglycaemia at hospital presentation is associated with poorer outcomes. Less is known about the risk of poorer outcomes according to achieved glycaemia early in the admission.Research design/methods: This was a retrospective observational study of patients admitted to non-critical care wards. The aim was to determine the relationship between the day 2 peak blood glucose and the occurrence of hospital-acquired complications (HACs) or in-hospital mortality. A Cox proportional hazards model, adjusted for relevant covariates, was used to evaluate the impact of day 2 peak glucose on HACs and in-hospital mortality, and we identified peak glucose thresholds correlating with an increase in risk.Results: For the whole cohort, day 2 peak glucose was associated with an increased risk of any HAC, aHR=1.06, 95% CI: 1.04, 1.07; but not in-hospital mortality, aHR=0.98, 95% CI: 0.94, 1.01. The risk of HAC infection increased by 4.6% for every mmol/L rise in day 2 peak glucose (aHR=1.05, 95% CI: 1.02, 1.08) in the diabetes cohort compared with 5.5% (aHR=1.06, 95% CI: 1.00, 1.11) in the non-diabetes cohort. The risk of HAC cardiac in the diabetes cohort increased by 5.3% (aHR=1.05, CI: 1.01, 1.10) per mmol/L increase in day 2 peak glucose; no association was found in the non-diabetes cohort (aHR=1.03, 95% CI: 0.94, 1.13). The risk for in-hospital mortality was associated with day 2 peak glucose, aHR=1.11, 95% CI: 1.03, 1.20, in patients without diabetes, but not in patients with diabetes, aHR=1.00, 95% CI: 0.95, 1.06. There was an increase in the risk of HAC once day 2 peak blood glucose exceeded 19.0 mmol/L (whole cohort), with thresholds of 13.6 mmol/L in the non-diabetes group and 19.5 mmol/L in the diabetes group.Conclusion: The peak glucose on day 2 was a predictor of HAC in the entire cohort and in-hospital mortality in patients without diabetes.

KW - Diabetes & Endocrinology

KW - General diabetes

KW - Hospitalization

UR - https://purl.org/au-research/grants/nhmrc/2006755

UR - https://www.scopus.com/pages/publications/85215363034

U2 - 10.1136/bmjopen-2024-089652

DO - 10.1136/bmjopen-2024-089652

M3 - Article

C2 - 39809558

SN - 2044-6055

VL - 15

SP - 1

EP - 9

JO - BMJ Open

JF - BMJ Open

IS - 1

M1 - e089652

ER -

Retrospective observational study of the association of peak blood glucose during the second 24 hours of admission with hospital-acquired complications in non-critical care admissions to a tertiary referral teaching hospital

Abstract

Bibliographical note

Keywords

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