Prognostic Value of Stress Hyperglycemia in Patients Admitted to Medical/Geriatric Departments for Acute Medical Illness

Abstract

Introduction: Hyperglycemia is common in patients admitted to Italian medical/geriatric units and is associated with a poorer outcome. We tested the significance of diabetes and stressinduced hyperglycemia in clinical outcome. Materials and Methods: Three hundred seventy-eight consecutive patients with hyperglycemia at entry (C 126 mg/dl) (206 without known diabetes) were included, with a wide range of underlying diseases requiring hospital admission and independent of the presence of diabetes. Relative hyperglycemia was calculated as admission glucose divided by average glucose, estimated based of glycosylated hemoglobin. Values C 1.20 were considered indicative of stress hyperglycemia (SHR). The association of SHR with outcome variables (all-cause complications, infections, non-infectious events, deaths) was tested by logistic regression analysis, adjusted for sex, BMI, age-adjusted comorbidities (Charlson index) and known diabetes. Results: During hospital stay, one or more events were registered in 96 patients (25.4%); 44 patients died in hospital, and fatality rate was borderline higher in patients without diabetes (14.6% vs. 8.1% in diabetes; P = 0.052) and nearly three times higher in patients with stress hyperglycemia (15.0%) vs. those with SHR \ 1.2 (P = 0.005). Stress hyperglycemia-more common in the absence of diabetes (71% vs. 58%)and age were the only independent prognostic factors for death. At multivariable analysis, the risks of death (OR 4.31, 95% CI 1.25-14.81), of all complications (OR 5.90, 95% CI 2.22-15.71) and of newly developed systemic infections (OR 5.67, 95% CI 1.61-19.92) were associated with stress hyperglycemia in subjects without diabetes, as was the risk in non-insulin-treated cases (OR 4.02, OR 5.47, OR 5.15, respectively). Conclusion:The study confirms the prognostic value of stress-related hyperglycemia in patients requiring hospital admission to a geriatric/ medical unit for a variety of acute medical

Stress hyperglycemia ratio, rather than admission blood glucose, predicts in-hospital mortality and adverse outcomes in moderate-to severe COVID-19 patients, irrespective of pre-existing glycemic status

“…Prior studies considering an admission glucose values above 140 mg/dl as a diagnosis of SH reported rates of 35–40% [42] , [43] . In the past five years, several studies have shown that HbA1c-adjusted glycemic variables, like the stress hyperglycemia ratio, which have an adjustment factor for the chronic hyperglycaemic state, could be more appropriate biomarkers for predicting worse outcomes in higher risk of certain critical illnesses [4] , [7] , [11] , [44] , [45] [The high prevalence of SH seen in our study could be related to the combined effects of SARS-CoV2 mediated beta cell dysfunction, effect of pro inflammatory cytokines and hypoxia in addition to other stress induced factors. Hypoxia has been shown to cause acute rise in blood glucose levels, possibly mediated by increased release of epinephrine [46] This is borne out by the fact that greater degrees of hypoxia and higher levels of pro-inflammatory cytokines were seen in those with SHR ≥ 1.14 in our study.…”

Relationship between cytokine release and stress hyperglycemia in patients hospitalized with COVID-19 infection

“…important, presence of stress hyperglycemia is an independent predictor of the clinical outcome of COVID-19 patients, both in terms of likelihood of need of mechanical ventilation and death. Previous studies reported that stress hyperglycemia as assessed by SHR is a better prognostic indicator of clinical outcome than simple blood glucose measurement in patients with stroke (14), sepsis (2), trauma (15) acute myocardial infarction (16), and in patients admitted to general medical wards for acute illness (3). Previous studies have also reported that stress hyperglycemia is associated with poorer outcomes in patients hospitalized with COVID-19 infection (17).…”

Linee guida per la gestione del paziente adulto con diabete o con iperglicemia ricoverato in setting clinico non critico

“…L'analisi dei dati presenti in letteratura ha evidenziato che l'iperglicemia all'ammissione si associa ad an aumentato rischio di mortalità, ipoglicemie, re-ospedalizzazione e più lunga durata di degenza in pazienti ospedalizzati in setting non critico (43)(44)(45)(46).…”