Association between glucose-to-lymphocyte ratio and in-hospital mortality in intensive care patients with sepsis: A retrospective observational study based on Medical Information Mart for Intensive Care IV

Abstract

BackgroundThis study aimed to evaluate the association between the glucose-to-lymphocyte ratio (GLR) and in-hospital mortality in intensive care unit (ICUs) patients with sepsis.MethodsThis is a retrospective cohort study. Patients with sepsis from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database had their baseline data and in-hospital prognosis retrieved. Multivariable Cox regression analyses were applied to calculate adjusted hazard ratios (HR) with 95% confidence intervals (CI). Survival curves were plotted, and subgroup analyses were stratified by relevant covariates. To address the non-linearity relationship, curve fitting and a threshold effect analysis were performed.ResultsOf the 23,901 patients, 10,118 patients with sepsis were included. The overall in-hospital mortality rate was 17.1% (1,726/10,118). Adjusted for confounding factors in the multivariable Cox regression analysis models, when GLR was used as a categorical variable, patients in the highest GLR quartile had increased in-hospital mortality compared to patients in the lowest GLR quartile (HR = 1.26, 95% CI: 1.15–1.38). When GLR was used as a continuous variable, each unit increase in GLR was associated with a 2% increase in the prevalence of in-hospital mortality (adjusted HR = 1.02, 95% CI: 1.01–1.03, p = 0.001). Stratified analyses indicated that the correlation between the GLR and in-hospital mortality was stable. The non-linear relationship between GLR and in-hospital mortality was explored in a dose-dependent manner. In-hospital mortality increased by 67% (aHR = 1.67, 95% CI: 1.45–1.92) for every unit GLR increase. When GLR was beyond 1.68, in-hospital mortality did not significantly change (aHR: 1.04, 95% CI: 0.92–1.18).ConclusionThere is a non-linear relationship between GLR and in-hospital mortality in intensive care patients with sepsis. A higher GLR in ICU patients is associated with in-hospital mortality in the United States. However, further research is needed to confirm the findings.

Relationship between stress hyperglycemia ratio and allcause mortality in critically ill patients: Results from the MIMIC-IV database

“…Numerous studies have shown that ICU patients with SIH have an increased risk of worsening clinical outcomes (1,(7)(8)(9)(10)(11). SIH usually occurs in ICU patients and increases evidently within 48 hours in at least 50% of patients (16).…”

“…Previous studies have demonstrated gut and thrombus microbiota dysbiosis and the miR33/sirtuin 1 pathway increased pro-inflammatory and pro-coagulable state of coronary thrombi, and thrombus aspiration could reduce clinical outcomes in AMI patients with SIH (4)(5)(6). Up to now, numerous studies have demonstrated that SIH is associated with adverse outcomes in the intensive care unit (ICU) for critically ill patients (1,(7)(8)(9)(10)(11).…”

Systemic inflammation response index as a prognostic factor for patients with sepsis-associated acute kidney injury: a retrospective observational study

“…31 Evidence from clinical studies indicates that sepsis is associated with a decrease in the blood lymphocyte count, which may persist at low levels for up to 28 days. 32,33 The SIRI serves as an indicator of systemic inflammation. As the SIRI increased in the present study, we observed a notable rise in the neutrophil and monocyte counts accompanied by a reduction in the lymphocyte count.…”

“…31 Evidence from clinical studies indicates that sepsis is associated with a decrease in the blood lymphocyte count, which may persist at low levels for up to 28 days. 32,33…”

Clinical significance of serum glucose to lymphocyte ratio as a prognostic marker in peritoneal dialysis patients

“…demonstrated that GLR was an independent predictor of both overall and disease-free survival in gallbladder cancer [ 5 ]. Moreover, there is a nonlinear relationship between GLR and in-hospital mortality in intensive care patients with sepsis [ 6 ]. As an easily available biomarker, GLR can also be used independently to predict in-hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease [ 7 ].…”