DINGO Supplementary Material

This is the supplementary material for the research report titled: "Hyperglycemia in hospital: an independent marker of infection, acute kidney injury & stroke for hospital inpatients". The abstract of the research is as below:

Context: Hyperglycemia in hospital inpatients without pre-existing diabetes is associated with increased mortality. However, the independent contribution of hyperglycemia to healthcare-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.

Design: 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 nine clinical characteristics, was performed to allow interrogation of causality. To maintain the positivity assumption, patients with HbA1c >12.0% were excluded and pre-hospital treatment not adjusted for.

Setting: The Royal Melbourne Hospital, a quaternary referral hospital in Melbourne, Australia.

Patients: Admissions with at least two capillary glucose values and length of stay >24 hours were eligible, with half randomly sampled.

Outcome measures: HAI, AKI, stroke, and mortality.

Results: Of 2,558 included admissions, 1,147 (45%) experienced hyperglycemia in hospital. Following propensity-weighting and adjustment, hyperglycemia in hospital was found to, independently of nine covariables, contribute an increased risk of in-hospital HAI (130 [11.3%] vs.100 [7.1%], adjusted odds ratio [aOR] 1.03, 95% confidence interval [95%CI] 1.01-1.05, p=0.003), AKI (120 [10.5%] vs. 59 [4.2%], aOR 1.07, 95%CI 1.05-1.09, p<0.001), and stroke (10 [0.9%] vs. 1 [0.1%], aOR 1.05, 95%CI 1.04-1.06, p<0.001).

Conclusions: In hospital inpatients (HbA1c ≤12.0%), irrespective of diabetes status and pre-hospital glycaemia, hyperglycemia increases the risk of in-hospital HAI, AKI, and stroke compared with those not experiencing hyperglycemia.