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

Abstract

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.