Association between glycemic variability and acute kidney injury incidence in patients with cerebral infarction: an analysis of the MIMIC-IV database.

Abstract

Introduction: Glycemic variability (GV) is an increasingly important predictive indicator of vascular occlusion-related complications. Studies have demonstrated that a higher GV is associated with poor outcomes in patients with cerebral infarction (CI). The prognostic utility of GV in CI patients for predicting acute kidney injury (AKI) remains inadequately characterized. This investigation systematically examines the pathophysiological relationship between acute glycemic fluctuations and AKI development in CI populations, with particular emphasis on temporal patterns of glucose dysregulation.

Methods: This retrospective cohort analysis utilized data from the MIMIC-IV database, categorizing CI patients into quartiles based on GV metrics. Primary outcomes included AKI incidence and renal replacement therapy (RRT) initiation, with in-hospital mortality designated as the secondary endpoint. Analytical methodologies employed Kaplan-Meier survival curves with log-rank testing, multivariable-adjusted Cox proportional hazards regression, and logistic regression modeling to evaluate GV-AKI associations while controlling for critical confounders.

Results: The analytical cohort comprised 3,343 critically ill individuals extracted from the MIMIC-IV database. Kaplan-Meier curve analysis demonstrated progressively elevated cumulative risks of AKI development, RRT requirement, and in-hospital mortality among individuals with heightened GV. Following multivariable adjustment, logistic regression models and Cox proportional hazards analyses confirmed GV as an independent predictor of AKI progression, RRT dependency, and mortality risk in cerebral infarction patients.

Conclusion: This investigation identifies GV as an independent prognostic determinant for AKI development in cerebral infarction patients. GV demonstrates clinical utility as a biomarker for stratifying AKI risk in this population.