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

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

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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