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초록

AimStress hyperglycemia, occurring during stressful conditions in patients without preexisting diabetes, is associated with poor outcomes in critically ill patients. We investigated its impact on long-term outcomes in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT).Materials and MethodsThis retrospective cohort study included 11,013 adult patients without preexisting diabetes who received CRRT for >= 3 days between 2010 and 2019 and were discharged alive using the National Health Insurance Service database of South Korea. Stress hyperglycemia was defined as receiving oral hypoglycemic agents (OHAs) or insulin for at least 7 days.ResultsAmong survivors to discharge, 2409 (21.9%) patients received OHA/insulin treatment during hospitalization. Stress hyperglycemia was associated with a lower risk of mortality (adjusted hazard ratios [HR] = 0.92, 95% confidence interval [CI] = 0.86-0.99). However, the hyperglycemia group had a higher risk of acute myocardial infarction (MI) (HR = 1.53, 95% CI = 1.11-2.12) and revascularization procedures (adjusted HR = 1.41, 95% CI = 1.02-1.94). Furthermore, among patients who survived for at least 1 year and did not receive diabetes treatment within 1 year (n = 5100), the hyperglycemia group had a significantly higher risk of developing new-onset diabetes after discharge (HR = 10.10, 95% CI = 6.92-14.73).ConclusionsIn critically ill patients with AKI requiring CRRT and without preexisting diabetes, stress hyperglycemia was associated with a decreased risk of mortality but an increased risk of coronary events and new-onset diabetes after discharge.

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