MON-596 - Stress Hyperglycemia as an Acute Severity Phenotype in U.S. Cancer Hospitalizations: National Inpatient Sample, 2018-2022

Background: Hyperglycemia during acute illness may reflect physiologic stress rather than chronic metabolic disease. National estimates describing the association of stress hyperglycemia, defined as hyperglycemia without pre-existing diabetes, with inpatient severity and resource utilization in cancer hospitalizations are limited.

Methods: A serial cross-sectional, hospitalization-level analysis of the 2018 to 2022 Healthcare Cost and Utilization Project National Inpatient Sample (NIS) was performed, incorporating discharge weights with hospital clustering and stratification to generate nationally representative estimates. Adult hospitalizations with a principal diagnosis of malignancy were identified using ICD-10-CM codes C00 to C97 and D45 to D47. Diabetes was defined using any-diagnosis codes E08 to E13. Hyperglycemia was identified using inpatient diagnosis codes consistent with hyperglycemia and uncontrolled hyperglycemia. Stress hyperglycemia was defined as hyperglycemia in the absence of diabetes. The primary endpoint was All Patient Refined Diagnosis Related Group (APR-DRG) severity of illness subclass (ordinal). Extreme inpatient severity was defined as APR-DRG level 4. Secondary outcomes included in-hospital mortality, length of stay (LOS), and hospitalization cost. Survey-weighted multivariable models adjusted for age, sex, year, race, primary payer, ZIP income quartile, elective status, cancer type, and hospital characteristics.

Results: Among 961,848 unweighted cancer hospitalizations representing 4,809,239 hospitalizations nationally, the prevalence of diabetes, hyperglycemia, and stress hyperglycemia was 23.6%, 6.82%, and 2.09%, respectively. Mean APR-DRG severity was higher among hospitalizations with stress hyperglycemia than among hospitalizations without diabetes or hyperglycemia (3.02 vs 2.50), and extreme severity occurred more frequently (31.0% vs 15.6%). After adjustment, stress hyperglycemia remained independently associated with higher overall inpatient severity (β 0.45, 95% CI 0.42 to 0.48; p< 0.001) and increased odds of extreme inpatient severity (OR 2.25, 95% CI 2.06 to 2.45; p< 0.001). In-hospital mortality was 4.68% among stress hyperglycemia hospitalizations versus 4.34% in the reference group, while adjusted mortality was not significantly increased (OR 1.05; p=0.223). Stress hyperglycemia was associated with longer LOS (10.32 vs 6.64 days) and higher cost ($48,257 vs $29,765).

Conclusions: Stress hyperglycemia identifies a small but clinically important subset of cancer hospitalizations with markedly higher physiologic severity and substantially greater resource utilization, despite no independent increase in adjusted in-hospital mortality. This administrative phenotype may support inpatient risk stratification and operational planning in hospitalized oncology populations.

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