Correlation Between Glycemic Variability And Prognosis In Diabetic Patients With CKD In Intensive Care Unit

Objective:In recent years,glycemic variability(GV)has been shown to be an important factor associated with in-hospital mortality in critically ill patients.The correlation between coefficient of variation of glucose(GLUCV),one of the methods to evaluate blood glucose variability,and the long-term adverse prognosis of diabetes mellitus(DM)patients with chronic kidney disease(CKD)remains unclear.In this paper,the correlation of GLUCV on in-hospital mortality and30-day all-cause mortality of critically ill patients with diabetes mellitus complicated with chronic kidney disease was mainly explored in order to better manage blood glucose and improve long-term prognosis of patients.Methods:We retrospectively screened patients diagnosed with DM complicated with CKD from MIMIC-IV(medical information mart for intensive care-IV,MIMIC-IV)and extracted related data(such as blood glucose during hospitalization,laboratory indices,in-hospital death,and death within 30 days,etc).According to the prognosis during hospitalization,the patients were divided into the death group and the survival group.According to the coefficient of variation in glucose during hospitalization,it was divided into four groups,namely GLUCV group 1,GLUCV group 2,GLUCV group 3 and GLUCV4 group(GLUCV < 24,24-31,31-39 and ≥39,respectively).The general information,clinical and laboratory indices,complications and mortality of each group were compared.All baseline data were included and the relationship between risk factors and In-hospital mortality and 30-days mortality was analyzed by multivariate COX regression analysis.Age,sex,BMI and complications were included in the subgroup to analyze the relationship between risk factors and mortality during hospitalization and within 30 days.Spearman correlation analysis was performed to study the correlation between GLUCV and clinical and laboratory indicators.Kaplan-Meier curves were drawn to analyze the relationship between coefficient of variation in blood glucose and 30-day all-cause mortality in hospital for survival.Results:1.Comparison of electrolytes,blood lipids and renal function of patients with diabetes mellitus complicated with chronic kidney disease in the death group and the survival group,The results showed that blood potassium,creatinine,urea nitrogen,GLUCV and GFR in the death group were higher than those in the survival group(ALL P <0.05),and there were no significant differences in high-density lipoprotein,low-density lipoprotein,total cholesterol and triglyceride between the two groups(P >0.05).2.Analysis of risk factors related to in-hospital mortality of patients with diabetes mellitus and chronic kidney disease in intensive care unit showed that: All baseline data of the patients were included in the COX regression equation,and after screening and elimination by univariate COX regression analysis(elimination variable test level 0.10),age(HR=1.016, 95%CI 1.005-1.027,P<0.001),sepsis(HR=1.852,95%CI 1.471-2.333,P=0.023),GLUCV2 group(HR=0.639,95%CI 0.454-0.899,P=0.010)and GLUCV3 group(HR=0.668,95%CI0.476-0.936,P=0.019)were independent risk factors for death during hospitalization.3.Analysis of risk factors related to 30-day mortality in patients with diabetes mellitus and chronic kidney disease in intensive care unit showed that: All baseline data of the patients were included in the COX regression equation,and after screening and elimination by univariate COX regression analysis(elimination variable test level 0.10),age(HR=1.016,95%CI 1.005-1.027,P=0.004),continuous renal replacement therapy(HR=2.007,95%CI 1.562-2.578,P<0.001),creatinine(HR=0.926,95%CI 0.869-0.986,P=0.017),sepsis (HR=3.318,95%CI 1.862-2.886,P<0.001),glomerular filtration rate(HR=0.982,95%CI 0.973-0.991,P<0.001)and GLUCV3 group(HR=0.726,95%CI 0.528-0.999,P=0.049)were independent risk factors for death within 30 days.4.The correlation analysis results of laboratory indicators and GLUCV showed that the length of hospital stay,urea nitrogen,creatinine,blood potassium,glycosylated hemoglobin,glomerular filtration rate,blood sodium and BMI were correlated with GLUCV,P<0.05.Conclusions:1.Age,sepsis and GLUCV were independent risk factors for in-hospital mortality.2.Age,continuous renal replacement therapy,creatinine,glomerular filtration rate,sepsis,and GLUCV were independent risk factors for 30-day mortality.3.Blood glucose fluctuation level is closely related to the prognosis of patients with diabetes mellitus complicated with chronic kidney disease in intensive care unit.Blood glucose level in GLUCV2 group and GLUCV3 group has a protective effect on patients during hospitalization.4.The higher GLUCV level of diabetic patients with chronic kidney disease in intensive care unit,the higher values of urea nitrogen,creatinine,blood potassium and glycosylated hemoglobin,the longer the hospital stay,and the lower values of glomerular filtration rate,blood sodium and BMI.