Glycaemic penalty index as an independent predictor of healthcare‐associated infection in surgical inpatients: A nested cohort study from the STOIC ‐D surgery trial

AIMS: To evaluate the utility of the Glycemic Penalty Index (GPI), a validated tool for assessing risk of adversity associated with inpatient dysglycaemia in surgical intensive care patients, in predicting adverse clinical outcomes among surgical inpatients at a quaternary Australian hospital. METHODS: This nested cohort study analysed data from the control arm of the Specialist Treatment of Inpatients: Caring for Diabetes in Surgery (STOIC-D Surgery) randomised controlled trial. The GPI was calculated using blood glucose values to derive patient-day weighted mean GPI (PDWMGPI). Univariable and multivariable analyses assessed associations between GPI and the outcomes of healthcare-associated infection (HAI) and acute kidney injury. RESULTS: 691 surgical inpatients with diabetes receiving standard care were included. On multivariable analysis, increasing PDWMGPI was independently associated with healthcare-associated infection (odds ratio 1.02 per one-unit increase, 95% CI 1.01-1.04, p = 0.008). CONCLUSION: The association between PDWMGPI and HAI suggests that linearised summary glycaemic measures may support clinicians in identifying patients at increased risk of adverse inpatient outcomes related to glycaemic patterns when interpreted alongside clinical factors. The simplicity of GPI as a single score may assist risk stratification and prioritisation of specialist diabetes input in surgical inpatient settings.