Association between hyperglycemia at ICU admission and postoperative acute kidney injury in patients undergoing cardiac surgery:Analysis of the MIMIC-IV database

Background:This study aimed to explore the correlation between hyperglycemia at intensive care unit(ICU)admission and the incidence of acute kidney injury(AKI)in patients after cardiac surgery.Methods:We conducted a retrospective cohort study,in which clinical data were extracted from the Medical Information Mart for Intensive Care(MIMIC)-IV database.Adults(≥18 years)in the database who were admitted to the cardiovascular intensive care unit after cardiac surgery were enrolled.The primary outcome was the incidence of AKI within 7 days following ICU admission.Secondary outcomes included ICU mortality,hospital mortality,ICU length of stay,and the 28-day and 90-day mortality.Multivariable Cox regression analysis was used to assess the association between ICU-admission hyperglycemia and AKI incidence within 7 days of ICU admission.Different adjustment strategies were used to adjust for potential confounders.Patients were divided into three groups according to their highest blood glucose levels recorded within 24 h of ICU admission:no hyperglycemia(<140 mg/dL),mild hyperglycemia(140-200 mg/dL),and severe hyperglycemia(≥200 mg/dL).Results:Of the 6905 included patients,2201(31.9%)were female,and the median(IQR)age was 68.2(60.1-75.9)years.In all,1836(26.6%)patients had severe hyperglycemia.The incidence of AKI within 7 days of ICU admission,ICU mortality,and hospital mortality was significantly higher in patients with severe admission hyperglycemia than those with mild hyperglycemia or no hyperglycemia(80.3%vs.73.6% and 61.2%,respec-tively;2.8%vs.0.9% and 1.9%,respectively;and 3.4%vs.1.2% and 2.5%,respectively;all P<0.001).Severe hyperglycemia was a risk factor for 7-day AKI(Model 1:hazard ratio[HR]=1.4809,95%confidence interval[CI]:1.3126 to 1.6707;Model 2:HR=1.1639,95%CI:1.0176 to 1.3313;Model 3:HR=1.2014,95%CI:1.0490 to 1.3760;all P<0.050).Patients with normal glucose levels(glucose levels<140 mg/dL)had a higher 28-day mortality rate than those with severe hyperglycemia(glucose levels≥200 mg/dL)(4.0%vs.3.8%,P<0.001).Conclusions:In post-cardiac surgery patients,severe hyperglycemia within 24 h of ICU admission increases the risk of 7-day AKI,ICU mortality,and hospital mortality.Clinicians should be extra cautious regarding AKI among patients with hyperglycemia at ICU admission after cardiac surgery.

Analysis of the correlation between the longitudinal trajectory of SOFA scores and prognosis in patients with sepsis at 72 hour after admission based on group trajectory modeling

Background:To identify the distinct trajectories of the Sequential Organ Failure Assessment(SOFA)scores at 72 h for patients with sepsis in the Medical Information Mart for Intensive Care(MIMIC)-IV database and determine their effects on mortality and adverse clinical outcomes.Methods:A retrospective cohort study was carried out involving patients with sepsis from the MIMIC-IV database.Group-based trajectory modeling(GBTM)was used to identify the distinct trajectory groups for the SOFA scores in patients with sepsis in the intensive care unit(ICU).The Cox proportional hazards regression model was used to investigate the relationship between the longitudinal change trajectory of the SOFA score and mortality and adverse clinical outcomes.Results:A total of 16,743 patients with sepsis were included in the cohort.The median survival age was 66 years(interquartile range:54-76 years).The 7-day and 28-day in-hospital mortality were 6.0%and 17.6%,respectively.Five different trajectories of SOFA scores according to the model fitting standard were determined:group 1(32.8%),group 2(30.0%),group 3(17.6%),group 4(14.0%)and group 5(5.7%).Univariate and multivariate Cox regression analyses showed that,for different clinical outcomes,trajectory group 1 was used as the reference,while trajectory groups 2-5 were all risk factors associated with the outcome(P<0.001).Subgroup analysis revealed an interaction between the two covariates of age and mechanical ventilation and the different trajectory groups of patients’SOFA scores(P<0.05).Conclusion:This approach may help identify various groups of patients with sepsis,who may be at different levels of risk for adverse health outcomes,and provide subgroups with clinical importance.