The association of dynamic glycemic trajectories and 28-day mortality in ICU patients with gastric ulcer: a retrospective cohort study

Blood glucose fluctuations are associated with disease prognosis, but limited evidence is available regarding the glycemic dynamic trajectory and mortality in ICU patients with gastric ulcer (GU). Accordingly, we aimed to establish temporal relationships between 28-day glycemic trajectories and all-cause mortality in such patients, addressing knowledge gaps in metabolic management. Latent class growth modeling identified glycemic trajectories using longitudinal glucose measurements of 707 patients with GU in ICU from MIMIC-IV 3.0 (2008–2019). Multivariable Cox regression (adjusted for demographics, vital signs, laboratory markers, comorbidities, critical illness scores and therapeutic interventions) quantified mortality risk. Survival curves were plotted using Kaplan-Meier (K-M) analysis and restricted mean survival time analysis (RMST). Sensitivity analyses included subgroup stratification and missing data robustness testing. Two distinct trajectories emerged: stable normoglycemia (Group1 84.0%) and persistent hyperglycemia (Group2 16.0%). The 28-day mortality rate was 11.8% in Group 1 and 19.5% in Group 2 ( P = 0.026). Group 2 was associated with a 2.41-fold increased mortality risk (95% CI 1.34–4.33; P = 0.003). After full adjustment for covariates, Group 2 remained associated with a 2.13-fold increased mortality risk (95% CI 1.16–3.93; P = 0.015). In the most parsimonious model (LASSO-selected covariates), Group 2 remained significantly associated with increased mortality risk (HR = 1.86, 95% CI 1.04–3.30; P = 0.035). The K-M curve demonstrated significantly diverging survival probabilities between groups (log-rank P = 0.002). RMST was significantly reduced in hyperglycemia group (1.50 days, 95% CI 0.108–2.878, P = 0.035). Sensitivity analyses further confirmed the reliability of the results. This study provides an exploratory characterization of dynamic glycemic trajectory phenotypes in critical gastric ulceration.