Influenza continues to impose significant strain on intensive care units (ICUs), especially in seasons of capacity stress. Diabetes mellitus has a strong interaction with influenza, showing a high additional increased risk of severe complications and increased mortality. Glycemic variability (GV) may independently contribute to adverse outcomes in critically ill patients, but its role in influenza-associated critical illness remains unexplored. This study investigates the association between GV and clinical outcomes in critically ill patients hospitalized with influenza. We conducted a retrospective multicenter cohort study involving adult patients admitted with confirmed influenza to 23 ICUs across the Netherlands between November 2023 and March 2024, with at least 5 glucose measurements. GV was assessed using the coefficient of variation (CV) of all glucose measurements during ICU admission. Outcomes included ICU mortality, hospital mortality, insulin therapy, corticosteroid use and invasive mechanical ventilation. Associations were analyzed using competing risk models and Cox proportional hazards regression, adjusting for age, APACHE and diagnose of diabetes. A total of 279 patients were included. ICU mortality was similar in the lowest three CV quartiles (14.5%, 18.3% and 18.8%), but higher (32.9%) in the highest CV group. In patients without diabetes, each 10-percentage-point increase in CV was independently associated with a higher risk of ICU mortality, as well as treatment with insulin and corticosteroid therapy. No significant associations were observed in patients with pre-existing diabetes. Higher CV was associated with increased ICU mortality in patients with influenza, in our cohort particularly among those without pre-existing diabetes mellitus. These results, if confirmed, underscore the need for prospective studies to further evaluate the clinical utility of GV and CV as a prognostic marker. Not applicable.
Fluit et al. (Sat,) studied this question.