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Hyperglycemia during ICI Therapy: etiology, risk factors, and survival outcome
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DOI：10.1007/s40618-026-03018-8.png)
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Abstract
En 中文
The spectrum of hyperglycemia and its association with overall survival (OS) in patients receiving immune checkpoint inhibitors (ICIs) are not characterized. We retrospectively analyzed 4,119 patients who had received ≥ 1 dose of PD-1 or PD-L1 inhibitors during a period from July 1st 2018 to March 1st 2022 at the First Affiliated Hospital with Nanjing Medical University. We assessed the characteristics of patients with hyperglycemic during ICIs. Multivariable Cox regression models and Propensity score matching (PSM) were utilized to analyze the risk of hyperglycemic and OS differences. After excluded 1,283 patients without follow-up fasting blood glucose (FBG) data, 2,836 patients were included. 24.33% (690/2,836) patients experienced hyperglycemia during ICIs. In patients with new-onset hyperglycemia (n = 410), the main etiologies were steroid‑related (31.22%), new‑onset T2DM (27.32%), ICI‑T1DM (4.39%), and ICI‑pancreatitis (0.73%). Independent risk factors included pre‑existing diabetes (OR: 6.970, 95% CI: 4.841, 10.036), digestive system tumors (OR:1.862, 95% CI: 1.382, 2.509), supraphysiologic steroid use (OR:2.009, 95% CI: 1.494, 2.700), and baseline FBG (OR: 2.824, 95% CI: 2.485, 3.209). A prediction model incorporating these factors showed good discrimination (AUC 0.84, 95% CI 0.82–0.86). Multivariable and PSM analyses revealed no statistically significant association between glycemic status and OS, nor did ICI‑T1DM independently affect survival. A range of pathologies can contribute to elevated glucose, thus careful clinical assessment of those with hyperglycemia is required.
Keywords:
Immune checkpoint inhibitors
Hyperglycemic
Real-world cohort
Overall survival
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