Early Glycemic Variability from Routine Glucose Measurements, Diabetes Status, and In-Hospital Mortality in Sepsis: A 14-Year Retrospective Cohort Study
4 affiliations
- 1Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- 2Innovation and eHealth Center, Carol Davila University of Medicine and Pharmacy, 010451 Bucharest, Romania
- 3C.F.2 Clinical Hospital, 011464 Bucharest, Romania
- 4General Surgery Department, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
Abstract
Background/Objectives: The prognostic meaning of early glycemic variability in sepsis may depend on whether the patient has diabetes. We examined the association of pre-existing diabetes with in-hospital mortality and tested whether diabetes modifies the prognostic association of early glycemic variability estimated from routine glucose measurements. Methods: This study uses a single-center retrospective cohort of 10,832 adults with sepsis identified from discharge documentation at a Romanian tertiary hospital (2011–2024). Early glycemic variability was the coefficient of variation (CV) of glucose within 24 h of the first measurement, computable in 6450 patients (59.5%). Logistic models using diabetes-by-glycemic-parameter interactions were complemented by stratified, landmark and weighted analyses and by standardized absolute risks. Results: In-hospital mortality was 53.6%. Diabetes was associated with lower adjusted odds of death (odds ratio [OR] of 0.822; 95% confidence interval [CI] of 0.751–0.899), corresponding to a standardized mortality of 50.5% vs. 54.8% (risk difference, −4.3 percentage points); the difference was smaller among patients alive 24 h after the first measurement (−2.8 percentage points). Per 0.10 increase in CV-24 h, the OR for death was 1.137 (1.102–1.173) without and 1.034 (0.994–1.076) with diabetes (interaction p < 0.001); diabetes also modified the associations of mean glucose and hyperglycemia. The CV interaction persisted after weighting and among 24 h survivors but was attenuated when deaths within 48–72 h were excluded; CV added little to the discrimination. Conclusions: In this observational cohort, the same degree of early glycemic variability carried different prognostic meaning, mainly for short-term mortality, in patients with and without diabetes. Diabetes was associated with modestly lower observed mortality, which should not be read as a protective effect. These are prognostic associations, not independent effects, and they do not define glucose targets.
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BibTeX
@article{mușat2026early,
title = {{Early Glycemic Variability from Routine Glucose Measurements, Diabetes Status, and In-Hospital Mortality in Sepsis: A 14-Year Retrospective Cohort Study}},
author = {Florentina Mușat and Octavian Andronic and Alexandra Bolocan and Alina Mihaela Dobre and Daniel Ion and Dan Nicolae Păduraru},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218649},
url = {https://www.mdpi.com/2077-0383/15/21/8649},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Early Glycemic Variability from Routine Glucose Measurements, Diabetes Status, and In-Hospital Mortality in Sepsis: A 14-Year Retrospective Cohort Study
AU - Florentina Mușat
AU - Octavian Andronic
AU - Alexandra Bolocan
AU - Alina Mihaela Dobre
AU - Daniel Ion
AU - Dan Nicolae Păduraru
PY - 2026
DA - 2026/11/06
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218649
UR - https://www.mdpi.com/2077-0383/15/21/8649
AB - Background/Objectives: The prognostic meaning of early glycemic variability in sepsis may depend on whether the patient has diabetes. We examined the association of pre-existing diabetes with in-hospital mortality and tested whether diabetes modifies the prognostic association of early glycemic variability estimated from routine glucose measurements. Methods: This study uses a single-center retrospective cohort of 10,832 adults with sepsis identified from discharge documentation at a Romanian tertiary hospital (2011–2024). Early glycemic variability was the coefficient of variation (CV) of glucose within 24 h of the first measurement, computable in 6450 patients (59.5%). Logistic models using diabetes-by-glycemic-parameter interactions were complemented by stratified, landmark and weighted analyses and by standardized absolute risks. Results: In-hospital mortality was 53.6%. Diabetes was associated with lower adjusted odds of death (odds ratio [OR] of 0.822; 95% confidence interval [CI] of 0.751–0.899), corresponding to a standardized mortality of 50.5% vs. 54.8% (risk difference, −4.3 percentage points); the difference was smaller among patients alive 24 h after the first measurement (−2.8 percentage points). Per 0.10 increase in CV-24 h, the OR for death was 1.137 (1.102–1.173) without and 1.034 (0.994–1.076) with diabetes (interaction p < 0.001); diabetes also modified the associations of mean glucose and hyperglycemia. The CV interaction persisted after weighting and among 24 h survivors but was attenuated when deaths within 48–72 h were excluded; CV added little to the discrimination. Conclusions: In this observational cohort, the same degree of early glycemic variability carried different prognostic meaning, mainly for short-term mortality, in patients with and without diabetes. Diabetes was associated with modestly lower observed mortality, which should not be read as a protective effect. These are prognostic associations, not independent effects, and they do not define glucose targets.
SN - 2077-0383
ER -