Work

Early 48-h glucose-to-lymphocyte ratio trajectories and 28-day mortality in sepsis-associated acute kidney injury: a retrospective landmark secondary analysis using MIMIC-IV

Year: 2026

Type: article

Abstract: Purpose Sepsis-associated acute kidney injury (SA-AKI) is a common and clinically important phenotype of critical illness, yet early risk assessment still relies mainly on static variables. We evaluated whether early 48-hour glucose-to-lymphocyte ratio (GLR) trajectories were associated with 28-day mortality in critically ill patients with SA-AKI. Methods This retrospective landmark secondary analysis used a curated SA-AKI cohort derived from MIMIC-IV. Adults who survived beyond 48 hours, stayed in the intensive care unit for at least 24 hours, had no pre-existing renal disease or malignancy, and had paired glucose and lymphocyte measurements in the 0-24-hour and 24-48-hour windows were included. Patients were classified into four trajectory groups according to baseline GLR and early GLR change. Associations with 28-day mortality were examined using Kaplan-Meier analysis, multivariable Cox models, restricted cubic splines, and multiple-imputation sensitivity analyses. Results Among 1,179 included patients, 241 (20.4%) died within 28 days after the 48-hour landmark. In the fully adjusted model, the high baseline + increasing trajectory remained independently associated with higher mortality (HR 1.90, 95% CI 1.14–3.17; P = 0.014), whereas the high baseline + decreasing trajectory was attenuated (HR 1.49, 95% CI 0.93–2.38; P = 0.094). Baseline GLR analyzed continuously remained associated with mortality (HR 1.27 per unit increase in log[GLR0 + 1], 95% CI 1.09–1.48; P = 0.002), while absolute GLR change alone was not. Conclusion Compared with a single baseline value or a simple change metric, trajectory-based GLR assessment provided more clinically meaningful risk stratification in SA-AKI. Early dynamic metabolic-immune monitoring may therefore improve prognostic assessment in this population.

Source: Scientific Reports

DOI: 10.1038/s41598-026-61140-2