Liu Pengcheng, Li Ziqi, Tang Shanshan, Dou Weiguang, Liu Yuanyuan
High Dependency Unit, Beijing Jianjia Rehabilitation Hospital, Beijing, China.
Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.
Sci Rep. 2025 Aug 23;15(1):31021. doi: 10.1038/s41598-025-16212-0.
Heart failure is a significant global health challenge with high mortality rates. This study examines the association between glycemic variability and short-term mortality in critically ill heart failure patients. Data from the eICU Collaborative Research Database (eICU-CRD) and the Medical Information Mart for Intensive Care (MIMIC-IV) database were analyzed, including 23,744 heart failure patients. Glycemic variability, measured by the coefficient of variation of glucose levels during ICU stay, was categorized into quartiles. Multivariable logistic regression and Cox proportional hazards models were used to assess associations with in-hospital and 30-day mortality. Linear regression models were employed to evaluate the association with ICU length of stay. Dose-response relationships were explored using restricted cubic splines. The in-hospital and 30-day mortality rates were 15.0% and 17.6%, respectively. The median ICU length of stay was 3.1 days (IQR: 1.9-5.4). Patients in the highest glycemic variability quartile had a significantly higher risk of in-hospital mortality (OR: 1.77, 95% CI: 1.54-2.04) and 30-day mortality (HR: 1.37, 95% CI: 1.23-1.53) compared to the lowest quartile. Additionally, higher glycemic variability was associated with prolonged ICU stays, with each unit increase resulting in a 2.57-day extension (95% CI: 2.03-3.10, P < 0.001) after adjustment for covariates. A U-shaped association was observed for in-hospital mortality, while a linear relationship was seen for 30-day mortality. Sensitivity and subgroup analyses confirmed the robustness of these findings. Elevated glycemic variability is independently associated with increased short-term mortality and prolonged ICU stays in critically ill heart failure patients, highlighting the importance of managing blood glucose fluctuations to improve outcomes and reduce healthcare resource utilization.
心力衰竭是一项重大的全球健康挑战，死亡率很高。本研究探讨了危重症心力衰竭患者血糖变异性与短期死亡率之间的关联。分析了来自电子重症监护病房协作研究数据库（eICU-CRD）和重症监护医学信息集市（MIMIC-IV）数据库的数据，包括23744例心力衰竭患者。通过重症监护病房住院期间血糖水平的变异系数来衡量血糖变异性，并将其分为四分位数。采用多变量逻辑回归和Cox比例风险模型评估与住院和30天死亡率的关联。使用线性回归模型评估与重症监护病房住院时间的关联。采用受限立方样条探索剂量反应关系。住院和30天死亡率分别为15.0%和17.6%。重症监护病房住院时间的中位数为3.1天（四分位间距：1.9 - 5.4）。与最低四分位数相比，血糖变异性最高四分位数的患者住院死亡率（比值比：1.77，95%置信区间：1.54 - 2.04）和30天死亡率（风险比：1.37，95%置信区间：1.23 - 1.53）显著更高。此外，较高的血糖变异性与重症监护病房住院时间延长相关，在调整协变量后，每单位增加导致延长2.57天（95%置信区间：2.03 - 3.10，P < 0.001）。观察到住院死亡率呈U形关联，而30天死亡率呈线性关系。敏感性和亚组分析证实了这些发现的稳健性。血糖变异性升高与危重症心力衰竭患者短期死亡率增加和重症监护病房住院时间延长独立相关，突出了管理血糖波动以改善预后和减少医疗资源利用的重要性。
