Glycemic Variability As a Prognostic Factor for Mortality in Patients With Critical Illness: A Systematic Review and...

Area of Science:

• Critical care medicine
• Endocrinology
• Biostatistics

Background:

• Glycemic variability is a key concern in critical care.
• Understanding its association with mortality is crucial for patient outcomes.

Purpose of the Study:

• To systematically review and meta-analyze the link between glycemic variability metrics and short-term mortality in critically ill patients.
• To evaluate both time-domain and complexity-domain measures of glycemic variation.

Main Methods:

• Searched Embase, MEDLINE, and Cochrane databases up to November 3, 2023.
• Included 41 studies with 162,259 patients assessing glycemic variation and short-term ICU mortality.
• Used random-effects models for meta-analysis and assessed study quality and evidence certainty.

Main Results:

• Increased standard deviation, coefficient of variance, and glycemic lability index were probably associated with higher mortality (moderate certainty).
• Decreased time in range was also probably linked to increased mortality.
• Increased mean absolute glucose, mean amplitude of glycemic excursion, and detrended fluctuation analysis may be associated with increased mortality (low certainty).

Conclusions:

• A consistent association exists between elevated glycemic variability measures and increased short-term mortality in critically ill patients.
• Standardized measurement of glycemic variation and complexity is recommended.
• Further research should explore their role as therapeutic targets and prognostic markers.