Glycemic Comparison Index (GCI): A Retrospective Analysis of its Prognostic Value in ICU Patients with AMI and Diabetes

Abstract

Background: Acute myocardial infarction (AMI) significantly impacts global health, particularly in individuals with diabetes, highlighting the necessity for specialized glycemic management. This study introduces the Glycemic Comparison Index (GCI), a novel prognostic tool for AMI patients with diabetes, aiming to improve glucose management in critical care. Methods: A single-center retrospective analysis was conducted using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, focusing on ICU patients with concurrent AMI and diabetes. GCI was calculated by comparing mean blood glucose levels in the ICU to baseline glucose levels, with patients stratified into tertiles based on their GCI scores. The primary outcome assessed was one-year all-cause mortality, with secondary outcomes including hospital mortality, ICU-free days, and hypoglycemic events. Results: Among 622 patients, the high GCI group exhibited significantly higher one-year all-cause mortality (37% vs. 19% and 18% in medium and low groups, respectively; p < 0.001) and fewer ICU-free days within 28 days (p = 0.007). Conversely, the low GCI group was associated with an increased risk of hypoglycemia (44% vs. 29% and 15% in medium and high groups, respectively; p < 0.001). After adjusting for confounders, the high GCI group demonstrated a significantly elevated risk of one-year mortality compared to the medium and low group. Time-dependent ROC analysis confirmed GCI's prognostic value, with AUC values ranging from 0.671 at one month to 0.634 at 12 months. Conclusions: Higher GCI values are associated with increased one-year mortality and fewer ICU-free days in AMI patients with diabetes, whereas lower GCI values correlate with a higher risk of hypoglycemia. The GCI shows potential as a personalized prognostic tool, pending further validation