Association between glycemic variability and all-cause mortality in patients with sepsis-associated acute respiratory distress syndrome: a retrospective study based on the MIMIC database.

BACKGROUND

Both sepsis and acute respiratory distress syndrome (ARDS) are related to high mortality. Previous studies have demonstrated that glycemic variability (GV) is significantly associated with adverse outcomes in critically ill patients, including those with sepsis. However, no study has specifically examined the impact of GV on mortality in patients with sepsis-associated ARDS. Our study retrospectively analyzed the relation of GV to all-cause mortality (ACM) in this patient population.

METHODS

Clinical data of the patients with sepsis-associated ARDS were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database. GV was calculated, and the link of GV to ACM was examined through Kaplan-Meier (KM) survival curves and Cox proportional hazards regression (CPHR) models. The nonlinear association between GV and mortality risk, along with the identification of a potential risk threshold, was assessed via restricted cubic spline (RCS) curves.

RESULTS

There were 4,203 patients with sepsis-associated ARDS included in this study. KM analysis revealed significantly higher mortality in the high-GV group than in the low-GV group. CPHR analysis showed that increasing GV was independently related to a higher mortality risk in patients with sepsis-associated ARDS, and the adjusted hazard ratio (HR) of 28-day ACM was 1.009 (95% confidence interval (CI): 1.006-1.012). RCS modeling demonstrated a marked nonlinear relation of GV to death, with mortality risk increasing markedly when GV exceeded 21%. Subgroup analyses indicated significant interactions between GV and both age and furosemide use on 28-day ACM. The effect of GV on death was more prominent in patients who did not receive furosemide and in those younger than 60, and the HRs were 1.017 (95% CI: 1.011-1.023) and 1.012 (95% CI: 1.007-1.018).

CONCLUSIONS

Elevated GV is significantly related to increased ACM in patients with sepsis-associated ARDS. GV may serve as a potential prognostic indicator reflecting disease severity and metabolic instability in this population, thereby facilitating risk stratification.