Acute Hyperglycemia During Hospitalization, Nutritional Support, and Longer-Term Cardiovascular Outcomes: a...

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

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

This retrospective cohort study used U.S. National Clinical Cohort Collaborative data. We included 5,174,261 adults ≥ 18 years hospitalized between March 1st, 2020 and March 1st, 2022, excluding those with baseline diabetes, cardiovascular disease, or death during hospitalization or within 30 days post-discharge. 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 cardiovascular events occurring >30 days post-discharge, including physician-diagnosed cerebrovascular disorders, dysrhythmias, ischemic heart disease, heart failure, and thrombotic disorders. Median follow-up was 2.3 years (IQR:1.8, 3.4 years). Cox regression models estimated hazard ratios adjusted for demographics, hypertension, obesity, coronary artery disease, chronic kidney disease, chronic lung disease, and cardiovascular medication use.

Of 5,174,261 patients (mean [SD] age, 55 [21] years; 48.9% male; 67.2% white), 1,390,281 (26.8%) had acute hyperglycemia. Hyperglycemia was associated with higher risk of incident cardiovascular events (adjusted HR, 1.82 [95% CI, 1.80, 1.84]). Interactions between acute hyperglycemia and nutritional support 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.

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