Shuai Wen-Liang, Zhang Hong-Jin, Wang Na, Zhang Hang-Cheng, Zeng Qing-Tian, Wang Rui, Dong Yi-Fei
Department of Cardiovascular Medicine, The 2(nd) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, China.
Department of Cardiovascular Medicine, The 2(nd) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, China; Molecular Medicine of Jiangxi Key Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, 330006, China.
Diabetes Res Clin Pract. 2025 Mar;221:112009. doi: 10.1016/j.diabres.2025.112009. Epub 2025 Jan 25.
High glycemic variability (GV) often indicates a poor prognosis. Our aim is to investigate the relationship between GV and short and long-term mortality in critically ill heart failure (HF) patients.
We extracted data from the Medical Information Mart for Intensive Care IV database. The risks of in-hospital and 1-year mortality were calculated using Logistic and COX regression. In addition, mediation analysis was used to investigate the indirect effect of ventricular arrhythmias (VA) on in-hospital mortality.
Among 8,980 critically ill HF patients, the multifactorial regression analysis showed that high GV was associated with an increased risk of in-hospital and 1-year mortality (OR 1.69, 95 % CI 1.47-1.93; HR 1.12, 95 % CI 1.02-1.22). The Kaplan-Meier survival curve and restricted cubic spline plot also emphasized this association. Furthermore, the impact of GV on in-hospital mortality was partially mediated by VA (4.98%). And the increased risk of 1-year mortality associated with high GV was more significant in person with diabetes (p for interaction =0.018).
Our Study indicates that high GV may be an independent risk factor for short and long-term mortality in critically ill HF patients. Maintaining the stability of blood glucose can reduce adverse outcomes in critically ill HF patients.
高血糖变异性（GV）通常预示着预后不良。我们的目的是研究GV与危重心力衰竭（HF）患者短期和长期死亡率之间的关系。
我们从重症监护医学信息数据库IV中提取数据。使用逻辑回归和COX回归计算住院和1年死亡率的风险。此外，采用中介分析研究室性心律失常（VA）对住院死亡率的间接影响。
在8980例危重心力衰竭患者中，多因素回归分析显示，高GV与住院和1年死亡率风险增加相关（比值比1.69，95%置信区间1.47-1.93；风险比1.12，95%置信区间1.02-1.22）。Kaplan-Meier生存曲线和限制性立方样条图也强调了这种关联。此外，GV对住院死亡率的影响部分由VA介导（4.98%）。高GV与1年死亡率增加的风险在糖尿病患者中更显著（交互作用p=0.018）。
我们的研究表明，高GV可能是危重心力衰竭患者短期和长期死亡率的独立危险因素。维持血糖稳定可降低危重心力衰竭患者的不良结局。
