Glucose-to-Platelet Ratio as a Biochemical Indicator of Metabolic–Coagulation Imbalance and Mortality Risk in Critically Ill Patients with Ischemic Stroke: A MIMIC-IV Cohort Study

GPR as a Biochemical Marker of Metabolic–Coagulation Imbalance in Ischemic Stroke

  • Jie Peng Department of Critical Care Medicine, Zhujiang Hospital, Southern Medical University
  • Xingzhan Zhang Department of Intensive Care Unit, The People's Hospital Medical Group of Xiangzhou
  • Huanhuan Wu Department of Intensive Care Unit, The People's Hospital Medical Group of Xiangzhou
  • Hongzhi Chen Department of Intensive Care Unit, The People's Hospital Medical Group of Xiangzhou
  • Jianbin Guan Department of Critical Care Medicine, Zhujiang Hospital, Southern Medical University
  • Zhanguo Liu Department of Critical Care Medicine, Zhujiang Hospital, Southern Medical University
  • Xingxing Liu Department of Critical Care Medicine, Zhujiang Hospital, Southern Medical University
DOI: https://doi.org/10.5937/jomb0-66025
Keywords: Ischemic stroke, Glucose-to-platelet ratio, Biochemical marker, Metabolic–coagulation imbalance, Mortality

Abstract


Background: Early identification of high-risk patients with ischemic stroke in the intensive care unit (ICU) remains challenging. Biochemical markers reflecting the interplay between metabolic stress and coagulation–inflammatory pathways may provide improved prognostic value. The glucose-to-platelet ratio (GPR), a composite index derived from routine laboratory parameters, has emerged as a potential indicator of systemic metabolic–coagulation imbalance; however, its prognostic significance in critically ill ischemic stroke patients has not been fully elucidated.

Methods: This retrospective cohort study was conducted using the MIMIC-IV database. Adult patients with ischemic stroke undergoing their first ICU admission and with a length of stay ≥24 hours were included (n = 3686). After excluding patients with missing exposure data, 3536 individuals were analyzed. GPR was calculated as the ratio of the first measured blood glucose (mg/dL) to platelet count (×10⁹/L) within 24 hours of ICU admission. Participants were categorized into quartiles according to GPR levels. Kaplan–Meier survival analysis, multivariable Cox proportional hazards models, and restricted cubic spline analyses were employed to evaluate the association between GPR and 28- and 90-day all-cause mortality.

Results: In fully adjusted models, each unit increase in GPR was independently associated with increased risks of 28-day mortality (HR 1.11, 95% CI 1.03–1.21; P=0.009) and 90-day mortality (HR 1.09, 95% CI 1.01–1.17; P=0.002). Compared with the lowest quartile, patients in the highest GPR quartile exhibited significantly elevated risks of 28-day (HR 1.37, 95% CI 1.08–1.75; P=0.010) and 90-day mortality (HR 1.25, 95% CI 1.02–1.54; P=0.034). Kaplan–Meier curves demonstrated significantly reduced survival probabilities with increasing GPR levels (log-rank P<0.0001). Restricted cubic spline analyses confirmed a significant positive association between GPR and mortality without evidence of nonlinearity.

Conclusions: GPR, as an accessible biochemical marker integrating metabolic stress and coagulation–inflammatory status, was independently associated with short- and intermediate-term mortality in critically ill patients with ischemic stroke. These findings suggest that GPR may serve as a clinically applicable indicator of systemic metabolic–coagulation dysregulation and may contribute to early risk stratification in critical care settings.

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Published
2026/05/11
Issue
Ahead of print
Section
Original paper

Copyright (c) 2026 Jie Peng, Xingzhan Zhang, Huanhuan Wu, Hongzhi Chen, Jianbin Guan, Zhanguo Liu, Xingxing Liu

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