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<p>Acute ischemic stroke (AIS) continues to be a major cause of morbidity and mortality globally. In this study, we investigated whether the glucose-to-platelet ratio (GPR) provides prognostic information in critically ill patients with AIS, and we further tested the robustness of our findings using an independent validation cohort. We conducted a retrospective cohort analysis, using the MIMIC-IV database to derive the model and the eICU Collaborative Research Database (eICU-CRD) as an independent cohort for external validation. Patients were stratified into quartiles according to early ICU GPR. Cox proportional hazards models, restricted cubic spline (RCS) analyses, and Kaplan–Meier survival curves and receiver operating characteristic curve analyses comparing GPR with blood glucose and platelet count alone were used to assess the association between GPR and 28-day and 365-day mortality. In the MIMIC-IV cohort (<i>n</i> = 2,855), higher GPR was significantly associated with increased mortality. In the fully adjusted multivariable Cox model, GPR, analysed as a continuous variable, was associated with higher hazards of both 28-day mortality (HR = 1.06, 95% CI 1.02–1.11; <i>P</i> = 0.009) and 365-day mortality (HR = 1.08, 95% CI 1.04–1.12; <i>P</i> &lt; 0.001). RCS analyses indicated a linear association between GPR and mortality risk (P for non-linearity &gt; 0.05), and Kaplan–Meier curves demonstrated lower survival in patients with higher GPR (log-rank <i>P</i> &lt; 0.001). In ROC analyses, GPR showed higher AUCs than blood glucose or platelet count alone for both 28-day mortality (0.633 vs. 0.620 and 0.557) and 365-day mortality (0.632 vs. 0.625 and 0.573). In the independent eICU-CRD cohort, the relationship between GPR at admission and mortality was confirmed. This association persisted when GPR was analyzed as a continuous measure (HR 1.28, 95% CI 1.19–1.38) and when evaluated in categories (highest vs. lowest group: HR 1.74, 95% CI 1.35–2.24). The restricted cubic spline curves and Kaplan–Meier survival trends closely mirrored those obtained in MIMIC-IV. Moreover, subgroup analyses did not identify any meaningful effect modification across the main clinical subgroups. An elevated early ICU GPR serves as an independent predictor of both short-term and long-term mortality in critically ill AIS patients. Including GPR in clinical evaluations might aid early risk stratification and facilitate timely, targeted interventions.</p>

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Elevated glucose-to-platelet ratio predicts short- term and long-term mortality in critically ill patients with acute ischemic stroke

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月9日

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  • Meilei lv,
  • Sisi Chen,
  • Bei Sun,
  • Changfu Liu,
  • Yifu Zhuang,
  • Guanghui Zhang

摘要

Acute ischemic stroke (AIS) continues to be a major cause of morbidity and mortality globally. In this study, we investigated whether the glucose-to-platelet ratio (GPR) provides prognostic information in critically ill patients with AIS, and we further tested the robustness of our findings using an independent validation cohort. We conducted a retrospective cohort analysis, using the MIMIC-IV database to derive the model and the eICU Collaborative Research Database (eICU-CRD) as an independent cohort for external validation. Patients were stratified into quartiles according to early ICU GPR. Cox proportional hazards models, restricted cubic spline (RCS) analyses, and Kaplan–Meier survival curves and receiver operating characteristic curve analyses comparing GPR with blood glucose and platelet count alone were used to assess the association between GPR and 28-day and 365-day mortality. In the MIMIC-IV cohort (n = 2,855), higher GPR was significantly associated with increased mortality. In the fully adjusted multivariable Cox model, GPR, analysed as a continuous variable, was associated with higher hazards of both 28-day mortality (HR = 1.06, 95% CI 1.02–1.11; P = 0.009) and 365-day mortality (HR = 1.08, 95% CI 1.04–1.12; P < 0.001). RCS analyses indicated a linear association between GPR and mortality risk (P for non-linearity > 0.05), and Kaplan–Meier curves demonstrated lower survival in patients with higher GPR (log-rank P < 0.001). In ROC analyses, GPR showed higher AUCs than blood glucose or platelet count alone for both 28-day mortality (0.633 vs. 0.620 and 0.557) and 365-day mortality (0.632 vs. 0.625 and 0.573). In the independent eICU-CRD cohort, the relationship between GPR at admission and mortality was confirmed. This association persisted when GPR was analyzed as a continuous measure (HR 1.28, 95% CI 1.19–1.38) and when evaluated in categories (highest vs. lowest group: HR 1.74, 95% CI 1.35–2.24). The restricted cubic spline curves and Kaplan–Meier survival trends closely mirrored those obtained in MIMIC-IV. Moreover, subgroup analyses did not identify any meaningful effect modification across the main clinical subgroups. An elevated early ICU GPR serves as an independent predictor of both short-term and long-term mortality in critically ill AIS patients. Including GPR in clinical evaluations might aid early risk stratification and facilitate timely, targeted interventions.