Zhonghua wei zhong bing ji jiu yi xue · 2026
[Association between blood glucose trajectory and prognosis in septic patients in intensive care unit].
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Wang Hanbing, Wu Jingwen, Liu Junzhu, Xu Yan, Zhou Li, Jiang Chunling
Аннотация
OBJECTIVE: To investigate the relationship between dynamic blood glucose trajectories within 7 days of intensive care unit (ICU) admission and the risks of death and hypoglycemia in patients with sepsis.
METHODS: Based on data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV), adult patients with sepsis who had at least one blood glucose measurement per day within 7 days of ICU admission were selected as study subjects. Group-based trajectory modeling (GBTM) was used to analyze blood glucose trajectories within 7 days of ICU admission and determine the optimal number of subgroups. General patient information (gender, age, race, ICU type), disease status (disease severity scores, comorbidities), and monitoring, laboratory parameters, and treatments during the first 24 hours of ICU admission were collected. The primary outcome was the 28-day cumulative survival rate. Secondary outcomes included the 1-year cumulative survival rate, in-hospital mortality, ICU mortality, and the incidence of hypoglycemia. The clinical characteristics of patients with different glucose trajectories were analyzed. Kaplan-Meier survival curve was used to analyze the relationship between glucose trajectories and 28-day and 1-year cumulative survival. Multivariate Logistic regression analysis or Firth regression analysis was employed to explore the relationship between glucose trajectories and in-hospital death, ICU death, and the occurrence of hypoglycemia within 7 days of ICU admission.
RESULTS: A total of 8 923 patients were finally enrolled, with 5 274 males (59.11%) and 3 649 females (40.89%), and the age was 68 (57, 78) years. Based on GBTM analysis and clinical relevance, three glucose trajectory groups were ultimately identified. According to the dynamic blood glucose changes within 7 days of ICU admission: the sustained high-level group included 2 009 patients, characterized by persistent blood glucose levels of 10.0-11.1 mmol/L (180-200 mg/dL); the moderate-level group included 3 631 patients, characterized by persistent blood glucose levels of 7.2-8.0 mmol/L (130-145 mg/dL); the normal low-limit group included 3 283 patients, characterized by persistent blood glucose levels of 5.6-6.7 mmol/L (100-120 mg/dL). Analysis of clinical characteristics showed that as blood glucose levels increased, the proportion of patients with comorbid type 2 diabetes mellitus, blood lactic acid (Lac) levels, blood urea nitrogen (BUN) levels, and the proportion of using vasopressors increased gradually (all P<0.05). Kaplan-Meier survival curve showed that for both 28-day and 1-year survival, the cumulative survival rate was lowest in the sustained high-level group and highest in the normal low-limit group (28-day Log-rank test: χ 2=105.950, P<0.001; 1-year Log-rank test: χ 2=62.186, P<0.001). Multivariate Logistic regression analysis, after adjusting for relevant variables, revealed that as blood glucose levels increased, in-hospital mortality and ICU mortality gradually rised [in-hospital mortality rates for the normal low-limit, moderate-level, and sustained high-level groups were 10.66% (350/3 283), 14.51% (527/3 631), and 20.01% (402/2 009), respectively; ICU mortality rates were 7.46% (245/3 283), 10.80% (392/3 631), and 16.38% (329/2 009), respectively]. Using the sustained high-level group as reference, the in-hospital mortality and ICU mortality in the moderate-level and normal low-limit groups were reduced [in-hospital mortality: odds ratio (OR) and 95% confidence intervals (95%CI) were 0.677 (0.574-0.799) and 0.467 (0.385-0.557), respectively; ICU mortality: the OR and 95%CI were 0.627 (0.524-0.751) and 0.390 (0.316-0.480), respectively; all P<0.001]. Only 4 cases of hypoglycemia occurred in the entire cohort: 3 in the moderate-level group and 1 in the normal low-limit group. Firth regression analysis showed that there was no statistically significant difference in the incidence of hypoglycemia within 7 days of ICU admission among the different glucose trajectory groups.
CONCLUSIONS: Post-ICU admission blood glucose trajectory is closely associated with prognosis in patients with sepsis, with the highest mortality observed in patients with sustained hyperglycemia. Mortality gradually decreased as blood glucose levels decreased; maintaining blood glucose at a lower level of 5.6-6.7 mmol/L (100-120 mg/dL) was associated with the lowest mortality without increasing the risk of hypoglycemia.
METHODS: Based on data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV), adult patients with sepsis who had at least one blood glucose measurement per day within 7 days of ICU admission were selected as study subjects. Group-based trajectory modeling (GBTM) was used to analyze blood glucose trajectories within 7 days of ICU admission and determine the optimal number of subgroups. General patient information (gender, age, race, ICU type), disease status (disease severity scores, comorbidities), and monitoring, laboratory parameters, and treatments during the first 24 hours of ICU admission were collected. The primary outcome was the 28-day cumulative survival rate. Secondary outcomes included the 1-year cumulative survival rate, in-hospital mortality, ICU mortality, and the incidence of hypoglycemia. The clinical characteristics of patients with different glucose trajectories were analyzed. Kaplan-Meier survival curve was used to analyze the relationship between glucose trajectories and 28-day and 1-year cumulative survival. Multivariate Logistic regression analysis or Firth regression analysis was employed to explore the relationship between glucose trajectories and in-hospital death, ICU death, and the occurrence of hypoglycemia within 7 days of ICU admission.
RESULTS: A total of 8 923 patients were finally enrolled, with 5 274 males (59.11%) and 3 649 females (40.89%), and the age was 68 (57, 78) years. Based on GBTM analysis and clinical relevance, three glucose trajectory groups were ultimately identified. According to the dynamic blood glucose changes within 7 days of ICU admission: the sustained high-level group included 2 009 patients, characterized by persistent blood glucose levels of 10.0-11.1 mmol/L (180-200 mg/dL); the moderate-level group included 3 631 patients, characterized by persistent blood glucose levels of 7.2-8.0 mmol/L (130-145 mg/dL); the normal low-limit group included 3 283 patients, characterized by persistent blood glucose levels of 5.6-6.7 mmol/L (100-120 mg/dL). Analysis of clinical characteristics showed that as blood glucose levels increased, the proportion of patients with comorbid type 2 diabetes mellitus, blood lactic acid (Lac) levels, blood urea nitrogen (BUN) levels, and the proportion of using vasopressors increased gradually (all P<0.05). Kaplan-Meier survival curve showed that for both 28-day and 1-year survival, the cumulative survival rate was lowest in the sustained high-level group and highest in the normal low-limit group (28-day Log-rank test: χ 2=105.950, P<0.001; 1-year Log-rank test: χ 2=62.186, P<0.001). Multivariate Logistic regression analysis, after adjusting for relevant variables, revealed that as blood glucose levels increased, in-hospital mortality and ICU mortality gradually rised [in-hospital mortality rates for the normal low-limit, moderate-level, and sustained high-level groups were 10.66% (350/3 283), 14.51% (527/3 631), and 20.01% (402/2 009), respectively; ICU mortality rates were 7.46% (245/3 283), 10.80% (392/3 631), and 16.38% (329/2 009), respectively]. Using the sustained high-level group as reference, the in-hospital mortality and ICU mortality in the moderate-level and normal low-limit groups were reduced [in-hospital mortality: odds ratio (OR) and 95% confidence intervals (95%CI) were 0.677 (0.574-0.799) and 0.467 (0.385-0.557), respectively; ICU mortality: the OR and 95%CI were 0.627 (0.524-0.751) and 0.390 (0.316-0.480), respectively; all P<0.001]. Only 4 cases of hypoglycemia occurred in the entire cohort: 3 in the moderate-level group and 1 in the normal low-limit group. Firth regression analysis showed that there was no statistically significant difference in the incidence of hypoglycemia within 7 days of ICU admission among the different glucose trajectory groups.
CONCLUSIONS: Post-ICU admission blood glucose trajectory is closely associated with prognosis in patients with sepsis, with the highest mortality observed in patients with sustained hyperglycemia. Mortality gradually decreased as blood glucose levels decreased; maintaining blood glucose at a lower level of 5.6-6.7 mmol/L (100-120 mg/dL) was associated with the lowest mortality without increasing the risk of hypoglycemia.