Post-stroke mortality in ICU patients with serum glucose-potassium ratio: an analysis of MIMIC-IV database

 

Don't tell us what the mortality risk is; REDUCE IT! You blithering idiots can't think at all, can you?

Post-stroke mortality in ICU patients with serum glucose-potassium ratio: an analysis of MIMIC-IV database

Zhen Yuan¹Aoli Chen²Yunqing Zeng¹Jiwei Cheng^1*

• ¹Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
• ²Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China

Introduction: Acute ischemic stroke (AIS) patients admitted to the intensive care unit (ICU) have a high mortality rate, necessitating the early identification of those at risk of a poor prognosis. This study investigated the association between the blood glucose-to-potassium ratio (GPR) and the prognosis of AIS patients.

Methods: We conducted a retrospective cohort study using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The primary outcomes were 28-day, 90-day, and 1-year mortality rates following ICU admission. Multivariate Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Subgroup analyses, Kaplan–Meier survival curves, and restricted cubic spline models were employed to further evaluate the relationship between the GPR and mortality in AIS patients.

Results: A total of 2,636 AIS patients were included in the study, with a mean age of 69.4 ± 15.6 years. The 1-year mortality rate was 36.8% (n = 969). After adjusting for confounders, compared with the first quartile (Q1, GPR ≤ 1.39), the 1-year mortality risks for the second quartile (Q2, 1.39 < GPR ≤ 1.74), third quartile (Q3, 1.74 < GPR ≤ 2.25), and fourth quartile (Q4, GPR ≥ 2.25) were HR = 1.17 (95% CI: 0.95–1.43, p = 0.132), HR = 1.42 (95% CI: 1.17–1.73, p < 0.001), and HR = 1.61 (95% CI: 1.33–1.96, p < 0.001), respectively. Similar trends were observed for 28-day and 90-day mortality. Kaplan–Meier (KM) analysis revealed that groups with higher GPRs had higher mortality rates at 28 days, 90 days, and 1 year. Non-linear analysis further confirmed the presence of an inflection point in the association between the GPR and 365-day mortality, which was identified at GPR = 2.75. At ratios less than this threshold, the risk of mortality increased significantly with increasing GPR (HR: 1.466; 95% CI: 1.239–1.735; p < 0.001). However, above this ratio, the association plateaued and was no longer statistically significant (HR: 0.899; 95% CI: 0.726–1.113; p = 0.095).

Conclusion: The GPR is an independent predictor of poor prognosis in AIS patients admitted to the ICU. Higher GPRs are associated with increased 28-day and 90-day mortality rates, highlighting the potential utility of this ratio in risk stratification and clinical decision-making. A non-linear relationship was observed between the GPR and 365-day mortality, with an inflection point identified at GPR = 2.75.

1 Introduction

Stroke is a life-threatening and prevalent condition and is the second leading cause of death worldwide (1). Patients with severe stroke often experience systemic organ failure, which presents significant challenges for subsequent treatment (2). Early identification of key prognostic factors and timely intervention are crucial for improving patient outcomes. However, there is currently no universally recognized objective indicator for predicting the prognosis of patients with severe strokes. Research has shown that during the acute phase of stroke, blood glucose levels can significantly increase (3). In patients with severe acute stroke, dysregulated glucose metabolism can lead to infarct expansion and impaired neurological recovery (4). Additionally, blood potassium levels have been shown to influence the prognosis of stroke. A study involving 421 stroke patients revealed that lower plasma potassium levels were associated with worse clinical outcomes. This may be due to hypokalemia impairing brain cell function, exacerbating ischemic injury, and increasing the risk of arrhythmia (5). Therefore, the coexistence of hyperglycemia and hypokalemia is associated with a poorer stroke prognosis. The ratio of serum glucose to potassium (GPR) has been explored in clinical practice. Previous studies have identified the GPR as a risk factor for aneurysmal subarachnoid hemorrhage (6) and an important biomarker in traumatic brain injury (7). Recent research further suggested that the GPR may serve as a prognostic indicator for intracerebral hemorrhage and coronary artery disease (8, 9).

Previous studies have suggested that the glucose-to-potassium ratio (GPR) may serve as an indicator of the short-term prognosis of ischemic stroke patients (10). However, these studies were limited by small sample sizes and a focus solely on short-term mortality. The impact of the GPR on the long-term prognosis of patients with severe ischemic stroke remains unclear, and no studies have specifically investigated its association with mortality in ICU-admitted acute ischemic stroke (AIS) patients. Therefore, utilizing the MIMIC-IV database, this study included ICU patients with severe AIS to examine the relationship between the GPR and all-cause mortality at 28 days, 90 days, and 1 year in critically ill AIS patients. Our goal was to evaluate whether the GPR could serve as a biomarker for predicting the prognosis of severe AIS patients.

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