Liu Yuchen, Fu Houxin, Wang Yue, Sun Jingxuan, Zhang Rongting, Zhong Yi, Yang Tianquan, Han Yong, Xiang Yongjun, Yuan Bin, Zhou Ruxuan, Chen Min, Wang Hangzhou
Department of Neurosurgery, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
Department of Pediatric Hematology and Oncology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
Front Endocrinol (Lausanne). 2025 Apr 3;16:1546164. doi: 10.3389/fendo.2025.1546164. eCollection 2025.
Elevated glycemic variability (GV) is commonly observed in intensive care unit (ICU) patients and has been associated with clinical outcomes. However, the relationship between GV and prognosis in ICU patients with hemorrhagic stroke (HS) remains unclear. This study aims to investigate the association between GV and short- and long-term all-cause mortality.
Clinical data for hemorrhagic stroke (HS) patients were obtained from the MIMIC-IV 3.1 database. GV was quantified using the coefficient of variation (CV), calculated as the ratio of the standard deviation to the mean blood glucose level. The association between GV and clinical outcomes was analyzed using Cox proportional hazards regression models. Additionally, restricted cubic spline (RCS) curves were employed to examine the nonlinear relationship between GV and short- and long-term all-cause mortality.
A total of 2,240 ICU patients with HS were included in this study. In fully adjusted models, RCS analyses revealed a U-shaped association between the CV and both short- and long-term all-cause mortality (P for nonlinearity < 0.001 for all outcomes). Two-piecewise Cox regression models were subsequently applied to identify CV thresholds. The thresholds for all-cause mortality in ICU, during hospitalization, and at 30, 90, and 180 days were determined to be 0.14, 0.16, 0.155, 0.14, and 0.14, respectively. These findings were consistent in sensitivity and subgroup analyses.
In HS patients, higher GV is associated with an increased risk of both short- and long-term all-cause mortality. Our findings suggest that stabilizing GV may improve the prognosis of HS patients.
在重症监护病房（ICU）患者中，血糖变异性（GV）升高较为常见，且与临床结局相关。然而，出血性卒中（HS）ICU患者中GV与预后的关系仍不清楚。本研究旨在探讨GV与短期和长期全因死亡率之间的关联。
从MIMIC-IV 3.1数据库中获取出血性卒中（HS）患者的临床数据。使用变异系数（CV）对GV进行量化，CV计算为标准差与平均血糖水平的比值。使用Cox比例风险回归模型分析GV与临床结局之间的关联。此外，采用受限立方样条（RCS）曲线来检验GV与短期和长期全因死亡率之间的非线性关系。
本研究共纳入2240例ICU出血性卒中患者。在完全调整模型中，RCS分析显示CV与短期和长期全因死亡率之间呈U形关联（所有结局的非线性P值均<0.001）。随后应用两段式Cox回归模型确定CV阈值。ICU、住院期间、30天、90天和180天全因死亡率的阈值分别确定为0.14、0.16、0.155、0.14和0.14。这些发现在敏感性和亚组分析中是一致的。
在HS患者中，较高的GV与短期和长期全因死亡率风险增加相关。我们的研究结果表明，稳定GV可能改善HS患者的预后。
