High blood glucose variability is associated with bacteremia and mortality in patients hospitalized with acute infection.

Background: Limited data are available regarding the association between glucose levels variability (GV) and outcomes of patients hospitalized with acute infectious diseases.

Objectives: To determine the association between GV and bacteremia, length of stay (LOS) and mortality.

Methods: A retrospective study of patients hospitalized in departments of medicine with respiratory tract, urinary tract and skin and soft tissue infections during 2011-2017. GV was assessed by the coefficient of variation (CV) of glucose levels during hospitalization and was divided into tertiles (CV ≤ 16%, 17-29%, >29%). LOS, bacteremia rates and all-cause mortality (30 days, 90 days and after 5 years) were evaluated for the patients with and without DM according the three GV categories.

Results: The study consisted of 1485 patients, 838 (56%) were diabetic. There was no significant association between GV and LOS. Bacteremia rates were higher in the upper GV tertile compared with the lower one (6% vs. 2%, p = 0.007). Mid and upper tertiles compared with the lower one were significantly associated with increased 30-day mortality (13% vs.5%, p = 0.005; and 40% vs.5%, p = 0.002 respectively). A decreased 5 years survival was observed for both diabetic and non-diabetic patients in the mid and upper GV tertiles [adjusted HRs 0.8 (95%CI, 0.6-1.04) and 0.6 (95% CI, 0.5-0.9) in diabetic patients and 0.7 (95% CI, 0.5-0.9) and 0.5 (95% CI, 0.3-0.7) in the non diabetic ones].

Conclusion: In diabetic and non-diabetic patients, hospitalized in non ICU setting with acute infectious diseases, increased GV is associated with increased risk of bacteremia, short and long-term mortality.