Relationship of glycemic variability with delirium and mortality among critically ill elderly patients with sepsis: A retrospective matched cohort study

OBJECTIVE: The associations of glycemic variability (GV) with the occurrence of delirium and 90-day and 180-day mortality in critically ill patients with sepsis remain unclear. This study aimed to investigate the associations of glycemic variability with the development of delirium and death. METHOD: This study employed a retrospective analysis of elderly sepsis patients admitted to the intensive care unit (ICU) for the first time. Patients were categorized into two groups based on their GV: a high-risk group (< 21.399%) and a low-risk group (≥21.39%). The relationship between GV and delirium was assessed via logistic regression and restricted cubic splines. Cox regression was employed to analyze the relationship between GV and patients' 90-day and 180-day mortality. RESULTS: This study included 12228 elderly patients who were diagnosed with sepsis. The high-risk group presented a significantly elevated risk of delirium (27.9% vs 22.1%) and higher 90-day (40.0% vs 30.1%) and 180-day (46.0% vs 35.7%) mortality rates (all p < 0.001). The increase in GV was approximately nonlinear with increasing risk of delirium. In addition, high GV was associated with the greatest risk among delirium (OR = 1.122, 95% CI 1.023-1.230), 90-day mortality (HR = 1.149, 95% CI 1.07-1.227) and 180-day mortality (HR = 1.153, 95% CI 1.085-1.224) in elderly sepsis patients. CONCLUSION: GV is independently associated increased risk of delirium and 90-day and 180-day mortality in elderly sepsis patients, indicating that GV can serve as a biomarker for identifying at higher risk of delirium and mortality in sepsis patients.