Frontiers in medicine · 2026
Impact of diabetes mellitus and glucose level control on early sepsis-associated acute kidney injury: a multicenter retrospective observational study.
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Zhao Lina, Cui Qian, Dong Shuoyan, Wang Hongyan, Yang Fei, Wang Yunying, Shi Hui, Shi Xiaopeng, Cao Dongming, Chen Zhe, Wang Yongwang, Li Yun
Аннотация
PURPOSE: Sepsis-associated acute kidney injury (SA-AKI) raises mortality risk, while the independent links of pre-existing diabetes mellitus (DM) and in-hospital glycemic status to SA-AKI remain unclear. This study explored their correlations with early SA-AKI among sepsis patients.
METHODS: This multicenter retrospective cohort enrolled 6,974 pathogen-positive adult sepsis patients admitted to ICUs from 2023 to 2026. We used pre-existing DM as the primary exposure and time-weighted average glucose as the secondary marker. Multiple adjustment methods including propensity score matching (PSM) and inverse probability weighting (IPW) were adopted to reduce confounding bias.
RESULT: After enrolling 6,947 septic ICU patients, multivariate logistic regression identified pre-existing DM as an independent risk factor for early SA-AKI (adjusted OR = 2.54, 95% CI 2.25-2.86, p < 0.001). The protective glycemic range was 6-11 mmol/L for diabetic patients (adjusted OR = 0.88, 95% CI 0.78-0.98, p = 0.025) and 8-13 mmol/L for non-diabetic patients (adjusted OR = 0.55, 95% CI 0.48-0.62, p < 0.001). PSM, IPW and doubly robust estimation all validated these consistent associations. Abnormal glucose showed weak predictive power for SA-AKI (AUC 0.60-0.61). Higher time-weighted glucose correlated with advanced AKI stages and increased in-hospital mortality in mild-to-moderate SA-AKI patients. Diabetic SA-AKI patients had higher proportions of stage 1 and stage 3 AKI without significant difference in overall in-hospital mortality compared with non-diabetic counterparts. Matched SA-AKI patients suffered longer ICU/hospital stays, more organ support use and higher hospital mortality.
CONCLUSION: Common pathogenic organisms had higher detection rates in SA-AKI cases. Pre-existing DM was positively correlated with early SA-AKI. Targeted in-hospital glycemic intervals were linked to lower SA-AKI risk, which supports individualized glucose monitoring for sepsis patients.
METHODS: This multicenter retrospective cohort enrolled 6,974 pathogen-positive adult sepsis patients admitted to ICUs from 2023 to 2026. We used pre-existing DM as the primary exposure and time-weighted average glucose as the secondary marker. Multiple adjustment methods including propensity score matching (PSM) and inverse probability weighting (IPW) were adopted to reduce confounding bias.
RESULT: After enrolling 6,947 septic ICU patients, multivariate logistic regression identified pre-existing DM as an independent risk factor for early SA-AKI (adjusted OR = 2.54, 95% CI 2.25-2.86, p < 0.001). The protective glycemic range was 6-11 mmol/L for diabetic patients (adjusted OR = 0.88, 95% CI 0.78-0.98, p = 0.025) and 8-13 mmol/L for non-diabetic patients (adjusted OR = 0.55, 95% CI 0.48-0.62, p < 0.001). PSM, IPW and doubly robust estimation all validated these consistent associations. Abnormal glucose showed weak predictive power for SA-AKI (AUC 0.60-0.61). Higher time-weighted glucose correlated with advanced AKI stages and increased in-hospital mortality in mild-to-moderate SA-AKI patients. Diabetic SA-AKI patients had higher proportions of stage 1 and stage 3 AKI without significant difference in overall in-hospital mortality compared with non-diabetic counterparts. Matched SA-AKI patients suffered longer ICU/hospital stays, more organ support use and higher hospital mortality.
CONCLUSION: Common pathogenic organisms had higher detection rates in SA-AKI cases. Pre-existing DM was positively correlated with early SA-AKI. Targeted in-hospital glycemic intervals were linked to lower SA-AKI risk, which supports individualized glucose monitoring for sepsis patients.