SA Pharmacy, Flinders Medical Centre, Bedford Park SA 5042, Australia; College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia.
College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia.
Diabetes Res Clin Pract. 2023 Nov;205:110955. doi: 10.1016/j.diabres.2023.110955. Epub 2023 Oct 14.
The association between stress-induced hyperglycaemia (SIH) and increased infection rates in hospitalised subjects is well-known. It is less clear if SIH at admission independently drives new-onset infections. We assessed the relationship between early exposure at admission to both the Stress Hyperglycaemia Ratio (SHR) and Blood Glucose (BG) with Hospital-Acquired Pneumonia (HAP).
This observational retrospective study included those with length-of-stay > 1 day, BG within 24 h of admission and recent haemoglobin A1c. SIH was defined as BG ≥ 10 mmol/L, or SHR ≥ 1.1, measured at both admission and as a 24-hour maximum. Multivariable analyses were adjusted for length-of-stay, age, mechanical ventilation, and chronic respiratory disease.
Of 5,339 eligible subjects, 110 (2.1%) experienced HAP. Admission SHR ≥ 1.1 was independently associated with HAP (OR 3.04, 95% CI 1.98-4.68, p < 0.0001) but not BG ≥ 10 mmol/L (OR 0.65, 95% CI 0.41-1.03, p = 0.0675). The association with SHR strengthened using maximum 24-hour values (OR 3.37, 95% CI 2.05-5.52, p < 0.0001) while BG ≥ 10 mmol/L remained insignificant (OR 0.96, 95% CI 0.63-1.46, p = 0.86). Of those experiencing HAP 40 (36.4%) occurred in subjects with no recorded BG ≥ 10 mmol/L but SHR ≥ 1.1.
SIH at admission defined as SHR ≥ 1.1, but not the conventional marker of BG ≥ 10 mmol/L, was independently associated with the subsequent onset of HAP, commonly at BG < 10 mmol/L.
应激性高血糖（SIH）与住院患者感染率增加之间的关联是众所周知的。但 SIH 是否会独立导致新发生的感染尚不清楚。我们评估了入院时早期暴露于应激血糖比（SHR）和血糖（BG）与医院获得性肺炎（HAP）之间的关系。
这项观察性回顾性研究纳入了住院时间超过 1 天、入院后 24 小时内有 BG 值且最近有血红蛋白 A1c 值的患者。SIH 定义为 BG≥10mmol/L，或 SHR≥1.1，在入院时和 24 小时最大值时均有测量。多变量分析调整了住院时间、年龄、机械通气和慢性呼吸系统疾病。
在 5339 名合格患者中，有 110 名（2.1%）发生了 HAP。入院时 SHR≥1.1 与 HAP 独立相关（OR 3.04，95%CI 1.98-4.68，p<0.0001），但与 BG≥10mmol/L 无关（OR 0.65，95%CI 0.41-1.03，p=0.0675）。使用最大 24 小时值时，与 SHR 的关联增强（OR 3.37，95%CI 2.05-5.52，p<0.0001），而 BG≥10mmol/L 仍无显著性（OR 0.96，95%CI 0.63-1.46，p=0.86）。在发生 HAP 的患者中，有 40 例（36.4%）的患者没有记录 BG≥10mmol/L，但 SHR≥1.1。
入院时定义为 SHR≥1.1 的 SIH，但不是常规的 BG≥10mmol/L 标志物，与随后发生的 HAP 独立相关，通常在 BG<10mmol/L 时发生。
