Glyceamic variability is a pridictor of in-hopital and long-term mortality of patients with dilated cardiomyopathy: a 5-year retrospective cohort study.

Abstract

Background: Dilated cardiomyopathy (DCM) is a major cause of heart failure with high morbidity and mortality, yet reliable prognostic markers remain limited. Glycaemic variability (GV), reflecting fluctuations in glucose levels, has been linked to adverse cardiovascular outcomes, but its role in DCM remains uncertain.

Methods: Data were obtained from Beth Israel Deaconess Medical Center in Boston. We included patients with DCM as the primary diagnosis and ≥ 3 glucose measurements during hospitalization. GV was defined as the natural logarithm of the standard deviation-to-mean glucose ratio and analyzed continuously and categorically (GV ≥ 2.9 vs. <2.9). Outcomes included in-hospital, and 1-, 3-, and 5-year all-cause mortalities. Multivariable Cox regression models were adjusted for demographic, clinical, and laboratory covariates.

Results: A total of 580 patients with DCM were included (mean age 64.20 (14.80); 73% male; 55% White). Patients with GV ≥ 2.9 had higher rates of in-hospital mortality (5.6% vs. 0.7%), ICU admission (52% vs. 28%) and worse long-term outcomes, including 1-year (20% vs. 10%), 3-year (26% vs. 17%), and 5-year (29% vs. 19%) mortalities. After adjusting for demographic, clinical, and laboratory variables, Each unit increase in GV increased the risk of in-hospital [adjusted OR(aOR): 5.12, 95% CI: 1.07-31.2], ICU admission (aOR 2.59),1-year [adjusted HR (aHR) 1.84], 3-year (aHR 1.65), and 5-year (aHR 1.60) death.

Conclusion: GV is associated with both short- and long-term mortality in patients with DCM. The cohort median GV value of 2.9 might help stratify patients according to clinical risk.