Predictive value of blood composite biomarkers for hemorrhagic transformation following mechanical thrombectomy in acute anterior circulation large vessel occlusion stroke patients

 In what multiverse are you living that you think any predictions directly leads to survivors recovery?

Predictive value of blood composite biomarkers for hemorrhagic transformation following mechanical thrombectomy in acute anterior circulation large vessel occlusion stroke patients

• 

  Mujie Yao 1,2

• J

  Jun Li 1,2

• S

  Sen Xu 1,2

• 

  Yue Wan 2*

• 1. School of Medicine, Wuhan University of Science and Technology, Wuhan, China

• 2. Department of Neurology, Hubei No. 3 People’s Hospital of Jianghan University, Wuhan, China

Abstract

Background: 

Hemorrhagic transformation (HT) is a devastating complication of mechanical thrombectomy (MT) for acute anterior circulation large vessel occlusion (LVO), yet reliable early prediction tools remain limited. This study systematically compared nine blood composite biomarkers to identify the optimal metabolic-immune integrative predictor of HT.

Methods: 

A total of 206 patients with acute anterior circulation LVO who underwent MT were retrospectively enrolled. Nine composite biomarkers were calculated from routine admission laboratory tests: platelet-to-lymphocyte ratio (PLR), neutrophil-to-platelet ratio (NPR), systemic inflammation response index (SIRI), pan-immune inflammation value (PIV), monocyte-to-HDL ratio (MHR), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), glucose-to-potassium ratio (GPR), and glucose-to-lymphocyte ratio (GLR). A stratified screening strategy was employed: elastic net regression for baseline variable selection, Spearman correlation for biomarker clustering, and univariate AUC with DeLong test for representative selection. Model evaluation incorporated discrimination (AUC with DeLong test and Bootstrap 1,000-iteration optimism correction), calibration (Hosmer-Lemeshow test and Brier score), and clinical net benefit (NRI, IDI, and decision curve analysis).

Results: 

HT occurred in 53 patients (25.7%). Elastic net regression identified six baseline variables: mean platelet volume, blood glucose, D-dimer, history of alcohol consumption, leukoaraiosis, and pulmonary infection. Spearman clustering yielded five representative biomarkers: GLR, SIRI, GPR, NPR, and MHR. Among these, GLR was the only biomarker that showed a trend toward improving? the baseline model’s discrimination (AUC: 0.852–0.882; △AUC = 0.030), although this difference did not reach statistical significance (P = 0.057). Bootstrap-corrected AUC for Base+GLR was 0.861. GLR also showed the most substantial calibration improvement (Hosmer-Lemeshow P = 0.858 vs. 0.081 for baseline; Brier score reduction 5.4%) and achieved significant integrated discrimination improvement (IDI = 0.0376, 95% CI: 0.002–0.078) and continuous net reclassification improvement (NRI = 0.712). Decision curve analysis revealed limited net benefit difference between GLR and the baseline model, suggesting GLR requires integration with multidimensional factors for comprehensive assessment.

Conclusion: 

Among nine composite biomarkers, GLR provides the greatest incremental predictive value for HT following MT in acute anterior circulation LVO patients. As a routinely accessible metabolic-immune integrative index, GLR may serve as an early warning layer for perioperative risk stratification, though integration with imaging and procedural information remains essential for clinical decision-making.

The glucose-to-potassium ratio: a predictor of poor functional outcomes in stroke patients receiving thrombolytic therapy

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And you've known of this since October 2024 and DID NOTHING TO SOLVE THE PROBLEM. EXTREME INCOMPETENCE DISPLAYED!

Association between the serum glucose-to-potassium ratio and clinical outcomes in ischemic stroke patients after endovascular thrombectomy October 2024 

The latest here:

The glucose-to-potassium ratio: a predictor of poor functional outcomes in stroke patients receiving thrombolytic therapy

Dong Zhang1†, Ruinan Ma1†, Xiaoyan Qin2†, Zhizhang Li1, Xiaoguang Zhang1, Ying Ding1, Yunqi Hu1 and Yunhua Yue1*

1Department of Neurology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China

2Department of Geriatrics, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China

Edited by

Jinming Han, Capital Medical University, China

Reviewed by

Aleksandras Vilionskis, Vilnius University, Lithuania

Aikaterini Theodorou, University General Hospital Attikon, Greece

*Correspondence

Yunhua Yue, yunhua.yue@tongji.edu.cn

†These authors have contributed equally to this work and share first authorship

Received 25 March 2025

Accepted 13 May 2025

Published 05 June 2025

Citation

Zhang D, Ma R, Qin X, Li Z, Zhang X, Ding Y, Hu Y and Yue Y (2025) The glucose-to-potassium ratio: a predictor of poor functional outcomes in stroke patients receiving thrombolytic therapy. Front. Neurol. 16:1581747. doi: 10.3389/fneur.2025.1581747

Background: 

The glucose-to-potassium ratio has shown promise as a biomarker in neurological disorders, but its prognostic value in acute ischemic stroke (AIS) after intravenous thrombolysis (IVT) continues to be uncertain. The study explores the relationship between admission GPR and 90-day functional outcomes in AIS patients undergoing IVT treatment.

Methods: 

A retrospective analysis included 649 AIS patients undergoing IVT between May 2016 and December 2023. Baseline clinical, laboratory, and imaging data were analyzed. GPR was calculated from serum glucose and potassium levels at admission. A modified Rankin Scale score of 3 to 6 at 90 days was used to define poor functional outcomes. Logistic regression and restricted cubic splines assessed the GPR-outcome relationship, adjusting for confounders. Receiver operating characteristic (ROC) analysis evaluated GPR’s predictive value.

Results: 

Among 649 patients, 174 (26.8%) had poor outcomes. Median GPR was significantly higher in these patients (2.14 vs. 1.88, p < 0.001). Higher GPR independently predicted negative consequences (OR, 1.821; 95% CI, 1.340–2.473, p < 0.001). Subgroup analysis indicated a stronger association in non-diabetic patients. ROC analysis demonstrated an area under the curve (AUC) of 0.631 (95% CI, 0.585–0.677, p < 0.001) for GPR in predicting poor functional outcomes.

Conclusion: 

High GPR levels are independently linked to unfavorable 90-day functional outcomes in AIS patients who received IVT, suggesting its potential as a prognostic biomarker. Further studies are warranted to validate these findings.

Keywords

intravenous thrombolysis; GPR; functional outcome; acute ischemic stroke; biomarkers

Association between the serum glucose-to-potassium ratio and clinical outcomes in ischemic stroke patients after endovascular thrombectomy

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Association between the serum glucose-to-potassium ratio and clinical outcomes in ischemic stroke patients after endovascular thrombectomy

Qianqian Zhang^1†Zhihang Huang^1†Shuaiyu Chen^1†E. Yan¹Xiaohao Zhang¹Mouxiao Su²Junshan Zhou¹Wei Wang^1*

• ¹Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
• ²Department of Neurology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China

Background and purpose: The baseline glucose-to-potassium ratio (GPR) is associated with poor outcomes in patients with acute brain injury and intracranial hemorrhage. However, the impact of serum GPR on clinical outcomes after endovascular thrombectomy (EVT) is unclear. This study aimed to evaluate the association between the GPR at admission and functional outcomes at 90 days after EVT.

Methods: We retrospectively reviewed our database for patients with acute ischemic stroke involving an anterior circulation large-vessel occlusion who received EVT between October 2019 and December 2021. The baseline serum GPR was measured after admission. The primary outcome was a 90-day poor outcome, which was defined as a modified Rankin scale score of 3–6.

Results: A total of 273 patients (mean age, 70.9 ± 11.9 years; 161 men) were finally included for analyses. During the 90-day follow-up, 151 patients (55.3%) experienced an unfavorable outcome. After adjusting for demographic characteristics and other potential confounders, the increased GPR was significantly associated with a higher risk of a 90-day poor outcome (odds ratio, 1.852; 95% confidence interval, 1.276–2.688, p = 0.001). Similar results were observed when the GPR was analyzed as a categorical variable. In addition, the restricted cubic spline observed a positive and linear association between the GPR and poor outcomes at 90 days (p = 0.329 for linearity; p = 0.001 for linearity).

Conclusion: Our study found that ischemic stroke patients with the higher GPR at admission were more likely to have an unfavorable prognosis at 3 months, suggesting that GPR may be a potential prognostic biomarker for ischemic stroke after EVT.

1 Introduction

Stroke causes 5.5 million deaths annually and is the second leading cause of death worldwide (1), contributing to a growing global socioeconomic burden. Endovascular thrombectomy (EVT) has been confirmed to be beneficial for ischemic stroke patients with large-artery occlusion (2). Currently, the time window of EVT has been extended to 24h after stroke for patients with anterior circulation large vessel occlusion (3). However, the death and disability rates are still high. Therefore, predicting the outcome of patients following EVT early and accurately is important. Currently, serum biomarkers are used to predict outcomes of ischemic stroke, including those following EVT (4). These biomarkers help guide clinical decision-making for patients undergoing EVT.

Glucose is the main source of energy to maintain cellular metabolism (5). Several studies have shown that elevated glucose levels are associated with worse clinical outcomes in patients after EVT (6). Potassium plays an important role in physiological processes (7). In large vessel occlusion stroke, the ion composition, including the potassium, has been distinctly altered (8). Due to the complex interactions between glucose and potassium in physiological processes, the serum glucose-to-potassium ratio (GPR) has been utilized in a few studies. It has been shown to serve as an early prognostic factor for acute brain injury (9), intracranial hemorrhage (10), and neuropsychiatric syndrome after carbon monoxide poisoning (11). More recently, data from a Norwegian cohort demonstrated that increased GPR was associated with higher short-term mortality in ischemic stroke patients (12). However, to the best of our knowledge, it remains unknown whether the serum GPR is related to the prognosis of ischemic stroke in those receiving EVT. We therefore performed this study to evaluate the association between GPR and functional outcome at 90 days after EVT based on a retrospective cohort.