Abstract:

Objective To explore the value of glycemic variability（GV） in predicting early enteral feeding intolerance（EFI） in critically ill patients，and provide a basis for precision nutrition management. Methods The 283 patients who initiated enteral nutrition in the ICU between June 2022 and June 2024 were enrolled. Patients were divided into a tolerance group and an intolerance group based on the occurrence of enteral feeding intolerance（EFI）. Data collected included general patient characteristics，laboratory parameters，clinical treatments，and blood glucose values，with glycemic variability（GV） calculated. Logistic regression and Cox proportional hazards regression analyses were used to identify independent risk factors for EFI，while receiver operating characteristic （ROC） curves was employed to evaluate the predictive efficacy of GV for EFI. Results Among the 283 patients，156 tolerated enteral feeding，while 127 developed EFI. The incidence of EFI was 44.87%，with primary manifestations of gastric retention（50.39%） and diarrhea（36.22%），mostly occurring between days 2 and 3 after nutrition initiation. Logistic and Cox regression indicated that pre-nutrition glucose standard deviation（GLUsd）（β=0.218，OR=1.244） and APACHE Ⅱ score（β=0.078，OR=1.081） were independent risk factors for EFI. ROC analysis showed that the AUCs for APACHE Ⅱ score and pre-nutrition GLUsd were 0.696 and 0.657，respectively，increasing to 0.723 when combined. Correspondingly，accuracy improved from 67.137% and 63.984% to 70.115%，with more balanced sensitivity and specificity. GV indicators during nutrition initiation did not show significant predictive value. Conclusion APACHE Ⅱ score and pre-nutrition GLUsd are both significant predictors of early enteral feeding intolerance，and their combination further enhances diagnostic efficacy. Clinically，the dual-dimensional assessment of metabolic stability and disease severity should be emphasized prior to nutrition support，in order to optimize nutritional management，reduce the incidence of EFI，and improve outcomes in critically ill patients.

Key words: Glycemic Variability, Enteral Feeding Intolerance, Critically Ill, APACHE Ⅱ, Nursing Care