ORIGINAL RESEARCH article
Front. Immunol.
Sec. Systems Immunology
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1610519
This article is part of the Research TopicExploring the Applications of Artificial Intelligence in Disease Screening, Diagnosis, Treatment, and NursingView all 4 articles
Identifying Early Blood Glucose Trajectories in Sepsis Linked to Distinct Long-term Outcomes: A K-means Clustering Study with External Validation
Provisionally accepted
huan Ma1Xiayan Qian1Xiaodong Song1Rongjie Jiang1
Jialin Li1
Xiao Fang1Ruoxu Dou1
Xiangdong Guan1Ka Yin Lui1*
Shuhe Li2*
Changjie Cai1*- 1The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- 2Medical School, College of Medicine and Health, University of Exeter, Exeter, England, United Kingdom
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Background: Blood glucose (BG) dysregulation, including hyperglycemia, hypoglycemia and increased glycemic variability (GV), is common in septic patients and potentially associated with poor clinical outcomes. However, the prognostic value of early BG trajectories remains unclear. We intend to investigate the association between the early dynamic trajectory of BG and 1-year mortality among sepsis patients.: This retrospective study comprises a derivation cohort of sepsis patients admitted to the First Affiliated Hospital of Sun Yat-sen University (FAH-SYSU) from January 2018 to December 2023, and an external validation cohort of 10,874 sepsis patients from the Medical Information Mart for Intensive Care (MIMIC) IV database.Distinct clusters were demarcated using K-means clustering based on the BG trajectory within the first 48 hours after ICU admission, while the optimal number of clusters was determined by a consensus of quantitative metrics and the elbow plot. Kaplan-Meier survival curves and multivariable Cox proportional hazards regression models were used to assess the association between these identified clusters and 1-year mortality.Results: Among 3,655 sepsis patients from the FAH-SYSU dataset, we identified 5 distinct clusters of BG trajectories, which were significantly associated with 1-year mortality risk. In the full Cox regression model, patients with "low-stable" and "moderate-stable" trajectories had the lowest 1-year mortality risk (P = 0.077).
Keywords: Sepsis, Blood Glucose, 1-year mortality, trajectory analysis, K-Means clustering
Received: 12 Apr 2025; Accepted: 20 May 2025.
Copyright: © 2025 Ma, Qian, Song, Jiang, Li, Fang, Dou, Guan, Lui, Li and Cai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ka Yin Lui, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
Shuhe Li, Medical School, College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, England, United Kingdom
Changjie Cai, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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