Glucose-to-potassium ratio has a non-linear J-shaped association with acute kidney injury risk in traumatic brain injury.

Overview

1. Department of Neurology, Yuxi People’s Hospital, Hongta District, Yuxi, 653100 Yunnan China

Abstract

Acute kidney injury (AKI) is a severe complication of traumatic brain injury (TBI) associated with poor prognosis. The glucose-to-potassium ratio (GPR), an emerging marker of metabolic stress, may play a role in post-TBI AKI, but its precise relationship is unclear. This retrospective cohort study investigated the association between early-admission GPR and AKI in 2,388 TBI patients from the MIMIC-IV database. Using multivariable logistic regression and restricted cubic spline (RCS) models, we explored both linear and non-linear associations. Of the patients, 56.7% (1,355/2,388) developed AKI. While a simple linear association between GPR and AKI was not significant after adjusting for confounders (P = 0.20), we discovered a significant non-linear "J-shaped" relationship (P for non-linearity = 0.012). The risk of AKI increased steeply once GPR surpassed an inflection point of approximately 30. A random forest model incorporating multiple clinical variables demonstrated significantly superior predictive performance (AUC = 0.808) compared to traditional logistic regression (AUC = 0.785; DeLong test P = 0.025). These findings reveal that a high GPR (> 30) acts as an independent non-linear risk indicator for post-TBI AKI, Rather than a direct driver of injury, an elevated GPR represents a valuable early warning signal for metabolic decompensation, suggesting clinicians should closely monitor high-risk patients to facilitate early recognition of AKI.

Supplementary Information: The online version contains supplementary material available at 10.1038/s41598-026-57082-4.

Reproduced under the paper's license (CC BY), from the paper cited above.

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Data

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• physionet.org/content/mimiciv, at PhysioNet; found in “Data availability”

Data availability

The data that support the findings of this study are publicly available in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (version 3.1), which can be accessed at https://physionet.org/content/mimiciv/3.1/. Access to the database requires completion of the CITI “Data or Specimens Only Research” training course.

Reproduced under the paper's license (CC BY), from the paper cited above.

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Version 1, 27 September 2026: the first record

Recorded: type, language, journal, volume, issue, pages, dates, 7 authors, 10 keywords, 14 MeSH terms, 39 references.

Cite

This paper

Wang, H., Dao, Q., Li, X., Shi, M., Yang, M., Gu, C., & Wang, J. (2026). Glucose-to-potassium ratio has a non-linear J-shaped association with acute kidney injury risk in traumatic brain injury. Scientific reports, 16(1), 26829. https://doi.org/10.1038/s41598-026-57082-4

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