The association between serum glucose to potassium ratio on admission and short-term mortality in ischemic stroke patients

Abstract

High serum glucose to potassium ratio (GPR) at admission is implicated for a poor outcome in acute brain injury, acute intracranial hemorrhage, and aneurysmal subarachnoid hemorrhage. However, the relationship between GPR and the outcome of ischemic stroke (IS) remains unknown. In all, 784 IS patients from a large emergency Norwegian cohort were included for secondary analysis. The exposure and outcome were GPR at baseline and all-cause mortality within 30 days after the first admission. Multivariable logistic regression analysis was performed to estimate the risk of 30-day mortality based on GPR levels. In addition, we examined whether there was a nonlinear relationship between admission GPR and 30-day mortality using two-piecewise linear regression with a smoothing function and threshold level analysis. The results of multivariable regression analysis showed that GPR at baseline was positively associated with the 30-day mortality (OR 2.01, 95% CI 1.12, 3.61) after adjusting for potential confounders (age, gender, department, serum sodium, serum albumin, serum-magnesium, hypertension, heart failure, chronic renal failure, and pneumonia). When GPR was translated to a categorical variable, the ORs and 95% CIs in the tertiles 2 to 3 versus the tertile 1 were 1.24 (0.60, 2.56) and 2.15 (1.09, 4.24), respectively (P for trend = 0.0188). Moreover, the results of the two-piecewise linear regression and curve fitting revealed a linear relationship between GPR and 30-day mortality. In IS patients, GPR is positively correlated with 30-day mortality, and the relationship between them is linear. The GPR at admission may be a promising predictor for the short-term outcome in IS patients.

The utility of serum glucose potassium ratio as a predictive factor for haemorrhagic transformation, stroke recurrence, and mortality among ischemic stroke patients

“…Our findings are consistent with a single-center retrospective cohort study that included 784 patients who arrived at an emergency in Norway between 2010 and 2015. Using the continuous model, the study found a significant positive correlation between GPR levels and 30-day mortality (OR 2.01 [95 % CI 1.12–3.61], p = 0.01) in ischemic stroke patients ( Lu et al, 2022 ). The study confirmed the results by categorizing GPR into three tertiles (GPR: Tertile 1: ≤ 1.372; Tertile 2: 1.375–1.658; Tertile 3: ≥ 1.659).…”

“…Following stress and brain trauma, catecholamines, cortisol, growth hormones, and cytokines are released due to the neuroendocrine response of the sympathetic nervous system ( Dungan et al, 2009 , Jayaraman et al, 2020 ). As a result, glucose levels rise, causing hyperglycemia, while potassium levels diminish, leading to hypokalemia ( Lu et al, 2022 , Thier, 1986 ). The Glucose-to-Potassium Ratio (GPR), which reflects glucose and potassium levels in the bloodstream, has emerged as a biomarker in various pathophysiological conditions sharing similarities with ischemic stroke, including aneurysmal subarachnoid hemorrhage ( Calviere et al, 2022 , Jung et al, 2021 , Matano et al, 2019 , Wang et al, 2021b ), acute intracerebral hemorrhage ( Wu et al, 2021 ), severe traumatic brain injury ( Marini and Sein, 2023 , Zhou et al, 2020 ), massive and non-massive pulmonary embolism ( Boyuk, 2022 ), and delayed neuropsychiatric syndrome after carbon monoxide poisoning ( Demirtaş et al, 2021 ).…”

“…The Glucose-to-Potassium Ratio (GPR), which reflects glucose and potassium levels in the bloodstream, has emerged as a biomarker in various pathophysiological conditions sharing similarities with ischemic stroke, including aneurysmal subarachnoid hemorrhage ( Calviere et al, 2022 , Jung et al, 2021 , Matano et al, 2019 , Wang et al, 2021b ), acute intracerebral hemorrhage ( Wu et al, 2021 ), severe traumatic brain injury ( Marini and Sein, 2023 , Zhou et al, 2020 ), massive and non-massive pulmonary embolism ( Boyuk, 2022 ), and delayed neuropsychiatric syndrome after carbon monoxide poisoning ( Demirtaş et al, 2021 ). Moreover, a recent study has shown a positive correlation between serum GPR and the risk of 30-day mortality in patients with ischemic stroke ( Lu et al, 2022 ).…”

PM2.5components mixture and atherosclerotic cardiovascular disease mortality: a national analysis of Medicare enrollees

“…Although research often focuses on the mass of PM2.5, its chemical composition is crucial. The composition of PM2.5 is complex, and the physical structure, chemical composition, and source of its components are diverse 7 . Therefore, PM2.5's individual chemical components can have distinct, cumulative, and potentially synergistic health impacts.…”

A prediction model of clinical outcomes in prolonged disorders of consciousness: A prospective cohort study

“…Low levels of serum albumin could aggravate the degree of brain edema and affect drug efficacy in patients after traumatic brain injury (Jungner et al, 2010). Albumin has been found to be associated with clinical outcomes in patients with traumatic brain injury (Wang et al, 2020) and ischemic stroke (Lu et al, 2022), but its predictive value of short-term clinical outcomes in patients with pDOC remains uncertain.…”