Combined impact of glucose variability and mineral disorders on mortality and severe cardiorenal events in critically ill CKD patients: a multicenter cohort study.

INTRODUCTION

Elderly critically ill ICU patients with CKD face high mortality. The independent and combined prognostic roles of glycemic variability (Glucose CV) and calcium-phosphate metabolic disorders in this population remain unconfirmed.

METHODS

This retrospective study contained three cohorts: MIMIC-IV (n = 1,319, development), multicenter eICU (n = 996, validation), and Chinese hospital cohort (n = 1,069, clinical validation). Multivariable Cox regression and meta-analysis were applied.

RESULTS

Elevated Glucose CV independently predicted 28- and 90-day mortality with predominant early risk. Concurrent hypocalcemia and hyperphosphatemia indicated the poorest prognosis, and high GV produced synergistic harmful effects in this subgroup. All results were verified by external cohorts.

DISCUSSION: Targeted glycemic variability management and calcium-phosphate homeostasis correction may effectively improve survival of elderly critically ill CKD patients.