Prognostic Value of Time-Weighted Average Glucose on All- Cause Mortality in Critically Ill Patients with Ischemic Stroke: A Retrospective Cohort Analysis

Background Ischemic stroke poses an increased risk of disability and mortality. Time-weighted average glucose (TWAG) represents an integrated index of glycemic exposure and serves as an independent prognostic marker in populations with critical illness. Nonetheless, its clinical significance for patients with ischemic stroke in intensive care units remains unclear. Investigating TWAG in critically ill patients with stroke may provide a promising approach to improving risk stratification in this vulnerable population. Methods This retrospective cohort study employed the MIMIC-IV database, encompassing 1,408 critically ill patients with ischemic stroke. Tertiles of TWAG values were defined on the basis of cutoff points at the 33rd and 66th percentiles. The main endpoint was 30-day all-cause mortality, with 90-day mortality assessed as a secondary outcome. Cox proportional hazards models, adjusted for demographic factors, illness severity scores, comorbidities, laboratory results, and treatment variables, were employed for assessing associations. Kaplan–Meier curves and restricted cubic spline plots were used for visualization, and subgroup analyses evaluated effect modifications related to diabetes status and other clinical characteristics. Results This study, comprising 1,408 patients with ischemic stroke, revealed that increased TWAG was significantly associated with higher short-term all-cause mortality, as estimated by Cox proportional hazards models. Subgroup evaluations further affirmed these associations. Conclusions In the intensive care setting, TWAG was independently correlated with increased short-term mortality in patients with ischemic stroke, with a stronger impact on individuals without diabetes. These findings suggest that TWAG can serve as a useful marker for early risk stratification and guide more targeted glycemic management protocols to improve clinical outcomes.