The additive effect of glycemic variability and systolic blood pressure variability on mortality in patients with...

Glycemic variability (GV) and systolic blood pressure variability (SBPV) have been reported to be associated with all-cause mortality. However, it remains unclear whether the combination of these parameters further stratifies mortality risk in septic patients admitted to the intensive care unit (ICU). The aim of this study was to investigate the combined association of GV and SBPV with mortality in patients with sepsis.

The study utilized data from MIMIC-IV database. Patients with sepsis were stratified into four groups. The endpoint indicators of this study include ICU mortality, in-hospital mortality, 30-day mortality, 90-day mortality, 180-day mortality, and 1-year mortality. Kaplan-Meier method was used to estimate the survival curves. The risks of ICU mortality, in-hospital mortality, and mortality at 30 days, 90 days, 180 days, and 1 year were assessed using Cox regression analyses. The study also performed subgroup analysis to evaluate the robustness of the findings. In addition, we evaluated the predictive value of GV and SBPV for mortality by calculating the Harrell C-index, IDI and NRI for each parameter separately and in combination.

Among 15,454 patients with sepsis, 1,576 patients died in ICU, and 5,189 patients died 1-year follow-up. High GV and high SBPV were associated with an increased risk of mortality. Patients with high GV and high SBPV have higher risk of ICU mortality (HR 1.56, 95% CI 1.32-1.85), in-hospital mortality (HR 1.46, 95% CI 1.26-1.69), 30-day mortality (HR 1.42, 95% CI 1.24-1.63), 90-day mortality (HR 1.32, 95% CI 1.17-1.49), 180-day mortality (HR 1.31, 95% CI 1.17-1.47), and 1-year mortality (HR 1.29, 95% CI 1.16-1.44) than those with low GV and low SBPV. Across all endpoints, the combination of GV and SBPV significantly improved predictive accuracy compared to GV or SBPV alone. Furthermore, the increased risk of mortality associated with high GV and high SBPV was more significant in patients with age < 60 (P for interaction < 0.001).

GV and SBPV were each independently associated with an increased risk of mortality in septic patients admitted to the ICU, and their combination demonstrated an additive association with mortality risk in this population. Monitoring and potentially managing these hemodynamic parameters may be important for risk stratification in severe sepsis.