中毒性脑病重症患者血清葡萄糖钾比值与死亡率之间的U型关系。

U shaped relationship between serum glucose potassium ratio and mortality in critically ill patients with toxic encephalopathy.

作者信息

Sun Lei, Shao Feng, Liu Ting, Jin Ping

机构信息

Department of Critical Care Medicine, Jingzhou Hospital Affiliated to Yangtze University, No.26 Chuyuan Avenue, Jingzhou District, Jingzhou, 434020, Hubei Province, China.

出版信息

Sci Rep. 2025 Jul 23;15(1):26795. doi: 10.1038/s41598-025-12496-4.

DOI:10.1038/s41598-025-12496-4

PMID:40702256

Abstract

The link between serum glucose-potassium ratio (GPR) and mortality in critically ill toxic encephalopathy (TE) patients is not well defined. This study has aimed to clarify the effect of GPR fluctuations on TE mortality. A total of 3,462 TE patients with TE requiring ICU care were selected from the Medical Information Mart Intensive Care (MIMIC-IV) database. Patients were categorized into three groups based on GPR tertiles: Tertile 1 (n = 1154, range 0.103-1.442), Tertile 2 (n = 1153, range 1.444-1.966), and Tertile 3 (n = 1155, range 1.967-12.937). The primary outcomes studied were 28-day and 90-day all-cause mortality (ACM). To analyze the relationship between GPR and outcomes, we employed Cox regression models adjusted for multiple covariates and restricted cubic splines to explore the potential non-linear association. The 3,462 - patient cohort had a mean age of 67.7 ± 16.6 years, with 58.2% male. The 28-day and 90-day ACM were 21.9% and 31.2%, respectively. Multivariate adjusted analysis showed no overall GPR-ACM correlation at 28 and 90 d. Regarding different groups, with T2 as the reference group (Ref), for 28-day ACM, the adjusted hazard ratio (HR) of the T1 was 1.20 (95% Confidence Interval [CI]: 1.00-1.44, p ≡ P = 0.049), and that of T3 group was 1.22 (95% CI: 1.01-1.47, P = 0.035). For 90 - day ACM, the adjusted HR of the T1 was 1.19 (95% CI: 1.02-1.39, P = 0.023), and the T3 was 1.20 (95% CI: 1.03-1.40). The correlation between the GPR lesvel and ACM was U-shaped association. The left and right - hand side effect sizes at the inflection point (1.65) were 0.472 (HR: 0.472, 95% CI 0.306-0.728, P < 0.001) and 1.127 (HR: 1.127, 95% CI 1.032-1.229, P = 0.0075). Sensitivity analysis was stable. Our findings have revealed a U-shaped relationship between GPR levels and ACM in critically ill patients with TE. Close attention should therefore be paid to this issue in order to improve patient care.

摘要

血清葡萄糖 - 钾比值（GPR）与危重症中毒性脑病（TE）患者死亡率之间的联系尚未明确界定。本研究旨在阐明GPR波动对TE患者死亡率的影响。从医学信息集市重症监护（MIMIC-IV）数据库中选取了3462例需要重症监护病房（ICU）护理的TE患者。根据GPR三分位数将患者分为三组：第一三分位数组（n = 1154，范围0.103 - 1.442）、第二三分位数组（n = 1153，范围1.444 - 1.966）和第三三分位数组（n = 1155，范围1.967 - 12.937）。研究的主要结局是28天和90天全因死亡率（ACM）。为分析GPR与结局之间的关系，我们采用了针对多个协变量进行调整的Cox回归模型，并使用受限立方样条来探索潜在的非线性关联。这3462例患者的队列平均年龄为67.7±16.6岁，男性占58.2%。28天和90天的ACM分别为21.9%和31.2%。多变量调整分析显示，在28天和90天时，GPR与ACM之间无总体相关性。对于不同组，以T2作为参照组（Ref），28天ACM方面，T1组的调整后风险比（HR）为1.20（95%置信区间[CI]：1.00 - 1.44，P = 0.049），T3组为1.22（95% CI：1.01 - 1.47，P = 0.035）。90天ACM方面，T1组的调整后HR为1.19（95% CI：1.02 - 1.39，P = 0.023），T3组为1.20（95% CI：1.03 - 1.40）。GPR水平与ACM之间的相关性呈U形关联。拐点（1.65）处左右两侧的效应量分别为0.472（HR：0.472，95% CI 0.306 - 0.728，P < 0.001）和1.127（HR：1.127，95% CI 1.032 - 1.229，P = 0.0075）。敏感性分析结果稳定。我们的研究结果揭示了危重症TE患者中GPR水平与ACM之间呈U形关系。因此，应密切关注此问题以改善患者护理。