The impact of glycemic variability on the 28-day prognosis of patients with cardiogenic shock with or without diabetes mellitus: A retrospective cohort study.

Unlabelled: Glycaemic variability (GV) may reflect sharp rises and acute fluctuations in blood glucose, which are associated with adverse cardiovascular events. The aim of this study was to investigate the effect of GV on 28-day outcome in patients with cardiogenic shock (CS) with or without diabetes mellitus (DM).

Methods: This retrospective cohort study adhered to the RECORD (REporting of studies Conducted using Observational Routinely-collected Data) guidelines. We used clinical data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. GV was assessed using the coefficient of variation of blood glucose levels and statistically analysed by dividing patients into three groups according to GV tertiles (GV1, GV2 and GV3), with a primary outcome of 28-day prognosis and secondary outcomes of mechanical ventilation status, length of hospital stay and length of ICU stay.

Results: A total of 1091 patients from the MIMIC-IV database with CS were included, of which a total of 409 (37.49 %) were male patients and 682 (62.51 %) were female patients. Based on GV levels, three groups were classified as GV1 (<16.2 %, n = 318), GV2 (16.2 %-25.3 %, n = 388), and GV3 (>25.3 %, n = 385). According to the Kaplan-Meier curves, the 28-day prognosis was significantly better in GV1 patients than in GV3 [220 (69.2 %) vs. 234 (60.8 %), P = 0.044], and the same was true in the Non-DM subgroup [188 (73.7 %) vs. 108 (61.4 %), P = 0.016]. In a multifactorial COX analysis, GV was significantly associated with the risk of 28-day mortality in patients [HR 1.42, 95 % CI 1.10-1.60, P = 0.012]. In the subgroup analyses, the risk of death was highest in the DM subgroup of patients with GV3 (HR: 1.53, p = 0.003).

Conclusion: GV significantly increases the 28-day risk of death in patients with CS, especially in DM patients. Future optimisation of glucose monitoring techniques and exploration of GV modulation strategies are needed to improve patient prognosis. What is known about this research topic: Glycaemic variability (GV) significantly increases the 28-day risk of death in patients with cardiogenic shock (CS). GV level (16.2 %-25.3 %) was an independent risk factor for 28-day mortality in patients with DM and CS, and GV (>25.3 %) was an independent risk factor for 28-day mortality in Non-DM patients with CS. What this study adds and its future implications: More optimal glucose monitoring techniques and GV modulation strategies need to be refined to improve patient outcomes.