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 of acute hyperglycemia and cardiovascular outcomes, particularly in the context of nutritional support influencing the relation, remains unexplained. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Acute hyperglycemia during hospitalization is associated with higher long-term cardiovascular risk, with pronounced associations among patients receiving parenteral or enteral nutrition.