Leukocyte Glycemic Index as a Predictor of 30-Day Mortality in Sepsis Patients with New-Onset Atrial Fibrillation: Insights from the MIMIC-IV Database

Leukocyte Glycemic Index as a Predictor of 30-Day Mortality in Sepsis Patients with New-Onset Atrial Fibrillation: Insights from the MIMIC-IV Database | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Leukocyte Glycemic Index as a Predictor of 30-Day Mortality in Sepsis Patients with New-Onset Atrial Fibrillation: Insights from the MIMIC-IV Database Yeyi Yang, Jia Kuang, Yingtai Chen, Lyufan Chen, Tiantian Jiao, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8805028/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 15 You are reading this latest preprint version Abstract Background To investigate the impact of leukocyte glycemic index (LGI) on the prognosis of sepsis patients with new-onset atrial fibrillation (NOAF). Methods This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database to evaluate adult patients with sepsis and new-onset atrial fibrillation (NOAF). The leukocyte glycemic index (LGI) was derived from the initial white blood cell count and blood glucose values recorded within 24 hours of intensive care unit admission, with log-transformation applied for analysis. Participants were divided into three groups according to LGI tertiles, employing 30-day all-cause mortality as the primary endpoint. Kaplan-Meier survival curves were constructed, with log-rank tests used to assess intergroup differences. Cox proportional hazards regression models and restricted cubic spline (RCS) analyses were applied to investigate the association and nonlinear relationship between LGI and the endpoint, complemented by subgroup analyses and interaction tests. Results A total of 691 patients were enrolled, exhibiting a 30-day all-cause mortality rate of 45.59%. The cohort had a median age of 72.93 years and comprised 418 males. Kaplan-Meier survival analysis revealed significantly higher mortality rates among patients with elevated LGI levels ( p < 0.05). Multivariable Cox proportional hazards models demonstrated that individuals in the highest LGI tertile faced a substantially increased risk of 30-day mortality relative to the reference tertile. Restricted cubic spline analysis (RCS) identified a significant U-shaped nonlinear association between log-transformed LGI and mortality, with an inflection point at 4.191; beyond this threshold, each one-unit increase in log-transformed LGI conferred a 36% higher mortality risk (HR = 1.36, 95%CI: 1.11–1.67, p = 0.003). Conclusions In patients with sepsis and new-onset atrial fibrillation, the leukocyte glycemic index exhibits a significant U-shaped nonlinear relationship with 30-day all-cause mortality. As a readily obtainable biomarker that integrates inflammatory intensity and glycemic dysregulation, LGI holds promise for enhancing early risk stratification and prognostic evaluation in this high-risk cohort. Prospective investigations are needed to corroborate these results and elucidate the underlying pathophysiological mechanisms. Health sciences/Biomarkers Health sciences/Cardiology Health sciences/Diseases Health sciences/Medical research Health sciences/Risk factors leukocyte glycemic index sepsis new-onset atrial fibrillation all-cause mortality prognosis Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterials.pdf Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 08 May, 2026 Reviews received at journal 07 May, 2026 Reviews received at journal 02 May, 2026 Reviews received at journal 25 Apr, 2026 Reviewers agreed at journal 23 Apr, 2026 Reviews received at journal 17 Apr, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviewers invited by journal 14 Apr, 2026 Editor invited by journal 11 Feb, 2026 Editor assigned by journal 07 Feb, 2026 Submission checks completed at journal 07 Feb, 2026 First submitted to journal 06 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8805028","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":626043856,"identity":"eafa0735-b270-441f-b71d-d8397665d0e5","order_by":0,"name":"Yeyi Yang","email":"","orcid":"","institution":"Renji Hospital Baoshan Branch, Shanghai Jiao Tong University Affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yeyi","middleName":"","lastName":"Yang","suffix":""},{"id":626043867,"identity":"59bd2a5e-d6bc-474e-bf00-07b0907329bb","order_by":1,"name":"Jia Kuang","email":"","orcid":"","institution":"Renji Hospital Baoshan Branch, 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Database\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"leukocyte glycemic index, sepsis, new-onset atrial fibrillation, all-cause mortality, prognosis","lastPublishedDoi":"10.21203/rs.3.rs-8805028/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8805028/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo investigate the impact of leukocyte glycemic index (LGI) on the prognosis of sepsis patients with new-onset atrial fibrillation (NOAF).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database to evaluate adult patients with sepsis and new-onset atrial fibrillation (NOAF). The leukocyte glycemic index (LGI) was derived from the initial white blood cell count and blood glucose values recorded within 24 hours of intensive care unit admission, with log-transformation applied for analysis. Participants were divided into three groups according to LGI tertiles, employing 30-day all-cause mortality as the primary endpoint. Kaplan-Meier survival curves were constructed, with log-rank tests used to assess intergroup differences. Cox proportional hazards regression models and restricted cubic spline (RCS) analyses were applied to investigate the association and nonlinear relationship between LGI and the endpoint, complemented by subgroup analyses and interaction tests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e A total of 691 patients were enrolled, exhibiting a 30-day all-cause mortality rate of 45.59%. The cohort had a median age of 72.93 years and comprised 418 males. Kaplan-Meier survival analysis revealed significantly higher mortality rates among patients with elevated LGI levels (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05). Multivariable Cox proportional hazards models demonstrated that individuals in the highest LGI tertile faced a substantially increased risk of 30-day mortality relative to the reference tertile. Restricted cubic spline analysis (RCS) identified a significant U-shaped nonlinear association between log-transformed LGI and mortality, with an inflection point at 4.191; beyond this threshold, each one-unit increase in log-transformed LGI conferred a 36% higher mortality risk (HR = 1.36, 95%CI: 1.11–1.67, \u003cem\u003ep\u003c/em\u003e = 0.003).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e In patients with sepsis and new-onset atrial fibrillation, the leukocyte glycemic index exhibits a significant U-shaped nonlinear relationship with 30-day all-cause mortality. As a readily obtainable biomarker that integrates inflammatory intensity and glycemic dysregulation, LGI holds promise for enhancing early risk stratification and prognostic evaluation in this high-risk cohort. Prospective investigations are needed to corroborate these results and elucidate the underlying pathophysiological mechanisms.\u003c/p\u003e","manuscriptTitle":"Leukocyte Glycemic Index as a Predictor of 30-Day Mortality in Sepsis Patients with New-Onset Atrial Fibrillation: Insights from the MIMIC-IV Database","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-22 23:47:58","doi":"10.21203/rs.3.rs-8805028/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-08T08:18:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T04:10:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-02T23:35:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-25T15:28:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"182030962826918123927787567423414259263","date":"2026-04-24T03:02:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-17T16:49:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20403688565234711987911770872532193157","date":"2026-04-17T00:42:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320925564336858390008014229757596298044","date":"2026-04-16T13:08:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"93417420521677739435819121902987039925","date":"2026-04-15T20:42:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106679090471258585925042108223732219055","date":"2026-04-15T18:05:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-14T17:40:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-12T03:34:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-07T05:05:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-07T05:03:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-02-06T08:39:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cf3a90e1-7289-4125-a802-62dc7d8b6236","owner":[],"postedDate":"April 22nd, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-08T08:18:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T04:10:34+00:00","index":111,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-02T23:35:16+00:00","index":110,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":66846088,"name":"Health sciences/Biomarkers"},{"id":66846089,"name":"Health sciences/Cardiology"},{"id":66846090,"name":"Health sciences/Diseases"},{"id":66846091,"name":"Health sciences/Medical research"},{"id":66846092,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-05-08T08:27:03+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-22 23:47:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8805028","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8805028","identity":"rs-8805028","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}