ArticleFrontiers in neurology
Prognostic significance and temporal patterns of glycemic variability in critically ill non-diabetic patients with ischemic stroke: a retrospective multicenter cohort study.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Critically ill patients with non-diabetic ischemic stroke (ND-IS) often exhibit significant blood glucose fluctuations, but traditional glycemic indicators fail to capture such dynamic changes. Evidence regarding the association of glycemic variability (GV) with outcomes in this patient population remains limited. In critically ill patients with ND-IS, this study sought to investigate the association of GV with all-cause mortality (ACM) at multiple follow-up points. Methods: This multicenter cohort study analyzed 2,971 ND-IS patients from MIMIC-IV database (original cohort) and Affiliated Hospital of North China University of Science and Technology (validation cohort) between December 2020 and November 2024. GV was calculated as the coefficient of variation (CV), and participants were divided into quartiles (Q1-Q4). Survival analysis (Kaplan-Meier) and multivariable Cox proportional hazards models were used to evaluate the independent association of GV with 28-, 90-, 180-, and 365-day ACM. Nonlinearity was evaluated with restricted cubic splines, and predictive performance was assessed via ROC curves, decision-curve analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results: In the original cohort, the median age was 70 years (IQR 59-80), and 51.9% of patients were male. ACM increased progressively across GV quartiles (Q4 vs. Q1: 28-day 25.1% vs. 11.2%; 365-day 32.0% vs. 12.8%; both Conclusion: Elevated GV is independently associated with increased short- and long-term ACM in critically ill patients with ND-IS. GV suggested a time-dependent association with both survival curves and dynamic physiological alterations in ND-IS patients. As a dynamic metabolic marker, GV highlights the potential of this dynamic metric to inform future strategies for risk assessment in critical care.
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