Prognostic value of glycaemic variability for mortality in cardiogenic shock patients: a retrospective cohort study

Cardiogenic shock (CS) represents a life-threatening cardiovascular condition with high mortality rates. Effective glycaemic management plays a critical role in treating CS patients. Glycaemic variability (GV), an increasingly recognized indicator of glycaemic control, has demonstrated significant associations with adverse outcomes across various disease. The prognostic implications of GV specifically in CS remain unclear. We investigated whether GV independently predicts all-cause mortality following ICU admission in this patient population.

This retrospective cohort study analyzed data from the Medical Information Mart for Intensive Care IV 3.0 (MIMIC-IV 3.0) database, focusing on patients with CS. The study endpoints were 30-day, 90-day, and 360-day all-cause mortality after ICU admission. The external validation was performed in eICU 2.0 database.

From 2008 to 2022, we enrolled 2335 CS patients from the MIMIC-IV 3.0 database in this study, the mean (SD) age of this cohort was 69.81 (14.29) years, 1413 (60.51%) were male. CS patients in higher GV quartiles had higher 30-day (31.7% vs. 36.1% vs. 37.8% vs. 47.3%, p < 0.001), 90-day (38.8% vs. 43.0% vs. 48.5% vs. 53.9%, p < 0.001), and 360-day (44.6% vs. 49.8% vs. 57.3% vs. 63.0%, p < 0.001) all-cause mortality. Multivariate Cox proportional hazards models revealed that higher GV quartiles were associated with higher risk of 30-day (Q4 vs. Q1: HR = 1.260, 95% CI 1.031, 1.540, p = 0.024), 90-day (Q4 vs. Q1: HR = 1.235, 95% CI 1.028, 1.485, p = 0.024), and 360-day (Q4 vs. Q1: HR = 1.323, 95% CI 1.115, 1.570, p = 0.001) all-cause mortality. Subgroup analysis revealed that the effect of GV was consistent across most subgroups except in patients with and without diabetes. In patients without diabetes, GV was associated with a significantly elevated risk of mortality, whereas no significant association was observed in patients with diabetes. Similarly, in 1100 CS patients from eICU 2.0 database reached similar findings that higher GV quartiles were associated with higher risk of in-ICU (Q4 vs. Q1: HR = 2.611, 95% CI 1.613, 4.226, p < 0.001) and in-hospital (Q4 vs. Q1: HR = 2.104, 95% CI 1.396, 3.171, p < 0.001) all-cause mortality.

GV is a significant predictor of 30-day, 90-day, and 360-day all-cause mortality after ICU admission in non-diabetic CS patients. GV may serve as a valuable marker for risk stratification and guiding subsequent interventions in CS non-diabetic patients, which emphasized the importance of stable control of blood glucose.