Blood glucose-to-potassium ratio and 90-day outcome in acute ischemic stroke patients of Caucasian origin treated by mechanical thrombectomy.

Abstract

Introduction: Existing evidence suggests that a high glucose-to-potassium ratio (GPR) is associated with poor outcomes in various conditions: acute, critical, and urgent. This study investigated the association of the GPR with 3-month functional outcomes in Caucasian patients with acute ischemic stroke (AIS), who underwent mechanical thrombectomy (MT), as well as its potential as a biomarker.

Material and methods: In a prospective study, 20 commonly available parameters in 464 patients with AIS were analyzed. Of these patients, 309 achieved a good outcome, defined as a modified Rankin Scale (mRS) score of 0-2, while 155 experienced an unfavorable outcome (mRS 3-6) at day 90.

Results: Both, univariate model and multivariate logistic regression model adjusted for age and sex, indicated that GPR was associated with an unfavorable outcome [odds ratio (OR) = 1.78; 95% confidence intervals (CI): 1.34-2.40, p < 0.001, OR = 1.68, 95% CI: 1.26-2.26, p < 0.001; respectively]. A further multivariate logistic regression model, adjusted for parameters with a significance threshold of 0.05 in univariate analysis, showed that an increased GPR (OR = 2.38, 95% CI: 1.48-3.90, p < 0.001) was linked to an unfavorable outcome. Additionally, factors such as older age (OR = 1.06, 95% CI: 1.03-1.10, p < 0.001), longer intervention duration (OR = 1.46, 95% CI: 0.99-2.13, p = 0.037), higher initial National Institutes of Health Stroke Scale (NIHSS) score (OR = 1.15, 95% CI: 1.09-1.23, p < 0.001), hemorrhagic transformation (HT) on computed tomography 24 h post-stroke onset (OR = 2.04, 95% CI: 1.08-3.86; p = 0.029), larger initial ischemic core volume on perfusion computed tomography (CT) (OR = 1.01, 95% CI: 1.00-1.02, p = 0.05), successful reperfusion (OR = 0.20, 95% CI: 0.08-0.49, p < 0.001), and higher C-reactive protein (CRP) levels (OR = 1.01, 95% CI: 1.00-1.03, p = 0.029) were also associated with an unfavorable outcome. Similar results were obtained when GPR was analyzed as a categorical variable. The relationship between GPR and the 90-day outcome was demonstrated to be linear. Receiver operating characteristics (ROC) analysis indicated an area under the curve (AUC) of 0.634 (95% CI: 0.580-0.688, p < 0.001) with sensitivity and specificity being 52.3% and 70.6%, respectively for GPR in predicting an unfavorable outcome at day 90.

Conclusions: It was confirmed that GPR was associated with unfavorable outcome at day 90 in AIS patients who received MT.

Clinical implications: Further studies on the significance of predictive value of GPR are required across various clinical scenarios, including different populations and outcome measures. Additionally, enhancing the predictive power of GPR by incorporating definitive disease biomarkers should be considered.