Acute hyperglycemia during hospitalization, nutritional support, and longer-term cardiovascular outcomes: a nationwide real-world data cohort study.

BACKGROUND

Acute hyperglycemia is not only a marker of acute illness severity but may also contribute to worse patient outcomes. However, the longer-term association between acute hyperglycemia and cardiovascular (CV) outcomes, particularly in the context of nutritional support influencing the relation, remains unexplained.

OBJECTIVES

To evaluate the long-term association between acute hyperglycemia during hospitalization and incident CV events after discharge, and to examine whether inpatient nutritional support modifies this risk.

METHODS

This retrospective cohort study used United States National Clinical Cohort Collaborative data. We included 5,174,261 adults aged ≥18 y hospitalized between 1 March, 2020 and 1 March, 2022, excluding those with baseline diabetes, CV disease (CVD), or death during hospitalization or within 30 d postdischarge. Acute hyperglycemia was defined as blood glucose >180 mg/dL without pre-existing diabetes. Nutritional support was defined as receipt of enteral or parenteral nutrition during hospitalization. The primary outcome was a composite of CV events occurring >30 d postdischarge, including physician-diagnosed cerebrovascular disorders, dysrhythmias, ischemic heart disease, heart failure, and thrombotic disorders. Median follow-up was 2.3 y (IQR: 1.8, 3.4 y). Cox regression models estimated hazard ratios (HR) adjusted for demographics, hypertension, obesity, coronary artery disease, chronic kidney disease, chronic lung disease, and CV medication use.

RESULTS

Of 5,174,261 patients [mean (SD) age, 55 (21) y; 48.9% male; 67.2% White], 1,390,281 (26.8%) had acute hyperglycemia. Hyperglycemia was associated with a higher risk of incident CV events [adjusted HR: 1.82; 95% confidence interval (CI): 1.80, 1.84]. Interactions between acute hyperglycemia and nutritional supports were statistically significant for parenteral (P < 0.01) and enteral feeding (P = 0.026). Stratified HRs were 2.11 (95% CI: 2.06, 2.16) for parenteral nutrition, 1.95 (95% CI: 1.92, 1.98) for enteral nutrition, and 1.35 (95% CI: 1.32, 1.38) without nutritional support.

CONCLUSIONS

Acute hyperglycemia during hospitalization is associated with higher long-term CVD risk, with pronounced associations among patients receiving parenteral or enteral nutrition.