Impact of intensive insulin therapy on dynamic cardiac function in critically ill patients with stress-induced...

Stress-induced hyperglycemia (SIH) is common in critically ill patients and has been associated with adverse cardiovascular outcomes. Intensive insulin therapy (IIT) has been proposed to mitigate these risks by achieving tighter glycemic control.

To evaluate the efficacy of IIT for managing SIH in critically ill patients and to explore its potential effect on cardiac function.

A retrospective study was conducted at our hospital from January 2021 to December 2024, adhering to STROBE guidelines. A total of 186 critically ill patients were divided into normal glycemia (n = 85) and SIH (n = 101) groups. The SIH cohort was further subdivided into conventional treatment (n = 50) and IIT (n = 51) groups. Hemodynamic parameters-including right atrial pressure (RAP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PAWP), cardiac output (CO), cardiac index (CI), and B-type natriuretic peptide (BNP)-were measured at baseline and post-treatment. Clinical outcomes such as intensive care unit (ICU) length of stay, mechanical ventilation requirements, and mortality were also recorded. Statistical analyses were conducted using independent samples t-tests and χ ²/Fisher's exact tests.

SIH markedly worsened haemodynamics versus normal glycaemia: RAP 9.8 ± 5.1 vs 6.1 ± 3.5 mmHg, PAP 35.2 ± 16.0 vs 26.2 ± 10.3 mmHg, PAWP 16.0 ± 7.0 vs 8.6 ± 6.4 mmHg, CO 3.3 ± 2.3 vs 6.0 ± 3.3 L/min, CI 1.88 ± 0.24 vs 2.70 ± 0.50 L/min/m², BNP 465 ± 250 vs 180 ± 53 pg/mL (all P < 0.001). Within the SIH cohort, IIT outperformed conventional therapy: RAP 7.0 ± 2.2 vs 8.3 ± 3.9 mmHg (P = 0.04), PAP 21.6 ± 3.7 vs 29.3 ± 6.5 mmHg (P < 0.001), PAWP 10.2 ± 5.4 vs 13.8 ± 5.3 mmHg (P = 0.001), CO 4.9 ± 2.2 vs 4.0 ± 1.4 L/min (P = 0.022), CI 2.58 ± 0.32 vs 2.11 ± 0.31 L/min/m², P < 0.001), BNP 202 ± 62 vs 346 ± 171 pg/mL (P < 0.001). Clinically, IIT shortened ICU stay (10.3 ± 3.4 vs 14.5 ± 2.6 days, P < 0.001), reduced ventilator use (56.9% vs 76.0%, P = 0.042), and lowered mortality (23.5% vs 42.0%, P = 0.048).

IIT significantly reduced cardiac filling pressures, improved cardiac function, and was associated with favorable clinical outcomes in SIH patients, suggesting potential benefits of stricter glycaemic control in critically ill patients. However, given the retrospective design and absence of glucose-variability monitoring, these findings should be interpreted with caution.