Bloodstream Infection After Major Burn Surgery in Relation to Preoperative Glycemic Gap Among Patients Without Diabetes: A Retrospective Cohort Study

Major burn injury induces stress-related hyperglycemia, but absolute glucose concentrations do not account for chronic glycemic status. The glycemic gap, defined as the difference between measured glucose and hemoglobin A1c (HbA1c)-derived estimated average glucose, may reflect acute glycemic deviation from chronic glycemia. We investigated the association between preoperative glycemic gap and 30-day postoperative bloodstream infection (BSI) in adult burn intensive care unit patients without diabetes. In this retrospective cohort study, 352 patients undergoing burn surgery between 2014 and 2024 were included, of whom 217 (61.6%) developed postoperative BSI. Each 10-mg/dL increase in preoperative glycemic gap was independently associated with higher odds of BSI (odds ratio, 1.104; 95% confidence interval, 1.036–1.184; p = 0.003) after adjustment for clinical factors, including burn severity. This association remained consistent in a sensitivity analysis using the revised Baux score. Adding either preoperative glucose or glycemic gap to the clinical model improved model fit, whereas improvements in discrimination were modest, with no significant difference between the glucose and glycemic gap models. A greater preoperative glycemic gap was independently associated with subsequent BSI in patients with major burns without diabetes and may provide complementary information regarding acute glycemic disturbance.