Objective:

To investigate the association of glycemic variability (GV) with all-cause mortality (ACM) at multiple follow-up points in critically ill patients with non-diabetic ischemic stroke (ND-IS).

Approach:

Key Findings:

• ACM increased progressively across GV quartiles (Q4 vs. Q1: 28-day 25.1% vs. 11.2%; 365-day 32.0% vs. 12.8%; both P<0.001).
• High GV was independently associated with increased risk of mortality (28-day HR=1.31, 95% CI 1.03–1.65; 365-day HR=1.49, 95% CI 1.24–1.79; both P<0.05).
• Nonlinear association observed: mortality risk increased steeply beyond GV of approximately 16–18% and plateaued around 36-38%.
• Adding GV to conventional severity models improved long-term prognostic accuracy.

Interpretation:

Elevated GV is independently associated with increased short- and long-term ACM in critically ill patients with ND-IS, suggesting its potential as a dynamic metabolic marker for risk assessment in critical care settings.

Conclusion:

GV highlights the potential of this dynamic metric to inform future strategies for risk assessment in critical care, emphasizing its role in improving patient outcomes.

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