Association of Glycemic Variability with Outcomes in Non-diabetic Sepsis Patients: A Prospective Observational Study.

Abstract

Background: Glycemic variability (GV) is the third domain of sepsis-induced dysglycemia, after hyperglycemia and hypoglycemia, potentially leading to adverse outcomes. This study analyzed the association of GV with in-hospital mortality and length of stay (LOS) in non-diabetic sepsis patients.

Materials and methods: In this prospective observational study, non-diabetic sepsis patients were followed till day 14 of hospital stay, and blood glucose levels were assessed by finger-prick method (seven times per day) daily; clinico-laboratory and GV parameters [standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE)] were assessed on days 1, 3, 5, 7, 10, and 14 of admission.

Results: Two hundred thirteen patients were screened and 80 (mean age 45.6 ± 15.37 years; 50% men) were included in the final analysis. Patients with in-hospital mortality had significantly higher GV when compared to patients without in-hospital mortality [SD: 37.57 vs 25.21, adjusted odds ratio (aOR) 1.13, 95% confidence interval (CI) 1.02-1.24, p = 0.013; CV: 24.91 vs 16.88, aOR 1.19, 95% CI: 1.03-1.38, p = 0.016; MAGE: 73.13 vs 48.03, aOR 1.05, 95% CI: 1.01-1.11, p = 0.014], independent of illness severity (APACHE II), mean blood glucose and hypoglycemia on multivariate regression analysis. There was no significant correlation between GV and LOS. Multivariate analysis showed a significant independent association between CV and ventilator requirement (aOR 1.15, 95% CI: 1.03-1.29, p = 0.017) and between SD and need for renal replacement therapy (aOR 1.04, 95% CI: 1-1.09, p = 0.044).

Conclusion: This study demonstrated that GV is independently associated with increased in-hospital mortality in non-diabetic sepsis patients. Further studies are required to investigate whether targeting lower GV in septic patients would translate to better outcomes.

Clinical significance: Glycemic variability in sepsis is controversial, with discordant results and a paucity of studies on the Indian population in the literature. Despite blood sugar monitoring being routinely done in sepsis patients, GV is rarely measured and the results of our study indicate that it may be worthwhile to estimate GV in sepsis. This may aid in identifying a subset of patients with increased mortality risk, who may benefit from intensive glucose monitoring and modification of insulin regimen.

How to cite this article: Prakash P, Sethi P, Vikram N, Khan M, Gupta Y, Jadon RS, et al. Association of Glycemic Variability with Outcomes in Non-diabetic Sepsis Patients: A Prospective Observational Study. Indian J Crit Care Med 2025;29(1):27-35.