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.