Chen PC, Tsai SH, Wang JC, et al. - In this study, researchers examined the value of stress-induced hyperglycemia (SIH), as determined by the glycemic gap between admission glucose levels and A1C-derived average glucose levels, in predicting adverse outcomes in diabetic patients hospitalized with necrotizing fasciitis (NF). In 252 diabetic patients hospitalized due to NF from 2011 to 2018 in a single medical center in Taiwan, the glycemic gap and clinical outcomes were retrospectively reviewed. Recruitment of 194 diabetic NF patients was done. Compared with patients without adverse outcomes, patients with adverse outcomes had significantly higher glycemic gaps. In diabetic NF patients, there was a significantly independent association of an elevated glycemic gap with adverse outcomes. Using the receiver operating characteristic curve, the optimal cutoff value of a glycemic gap was 146 mg/dL for predicting adverse outcomes. Relative to patients with glycemic gaps ≤ 146 mg/dL, those with glycemic gaps > 146 mg/dL exhibited higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores and incidence rates of adverse outcomes, especially bacteremia and acute kidney injury. As per the multivariate analysis, adverse outcomes could be independently predicted with a glycemic gap > 146 mg/dL and APACHE II score > 15, but not with the presence of hyperglycemia at admission.