Lou Jiaqi, Xiang Ziyi, Zhu Xiaoyu, Song Jingyao, Cui Shengyong, Li Jiliang, Jin Guoying, Huang Neng, Fan Youfen, Xu Sida
Burn Department, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China.
Institute of Pathology, Faculty of Medicine, University of Bonn, Bonn, Germany.
Front Endocrinol (Lausanne). 2025 Jul 30;16:1555082. doi: 10.3389/fendo.2025.1555082. eCollection 2025.
The glucose potassium ratio (GPR) is emerging as a biomarker for predicting clinical outcomes in various conditions. However, its value in sepsis patients admitted to the intensive care unit (ICU) remains unclear. Prior studies have shown conflicting results, with some indicating GPR's potential as an early warning indicator of metabolic decompensation in septic patients, while others found no significant association. The current study addresses these inconsistencies by conducting the first large-scale, systematic validation of GPR in ICU sepsis patients.
This retrospective cohort study used patient records from the MIMIC-IV database to examine outcomes in sepsis patients. The primary outcomes were hospital and ICU mortality at 30, 60, and 90 days. The correlation between GPR and these outcomes was evaluated using Kaplan-Meier survival analysis, Cox regression models, and restricted cubic spline (RCS) regression analysis. Sensitivity analyses, including Propensity Score Matching (PSM) and E-value Quantification and Subgroup analyses, were performed to assess the robustness of the findings.
The study included 9,108 patients with sepsis. Kaplan-Meier survival curves indicated progressively worsening survival probabilities from Q1 to Q4 for both hospital and ICU mortality across all time points. Cox analysis revealed that patients in the highest GPR quartile (Q4) had a significantly increased risk of mortality compared to those in the lowest quartile (Q1). A nonlinear relationship between GPR and mortality was identified, with a critical threshold at GPR=30. Subgroup analysis showed that the effect size and direction were consistent across different subgroups. Sensitivity analyses, including E-value quantification and propensity score matching, supported the robustness of our findings.
This study demonstrates that higher GPR levels strongly predict increased short- and long-term mortality risk in ICU-admitted sepsis patients. The composite nature of GPR, reflecting both hyperglycemia and hypokalemia, offers incremental prognostic value beyond single metabolic parameter. A critical threshold effect was observed at GPR=30, where risk substantially increased. This consistent association across patient subgroups positions GPR as a promising biomarker for identifying high-risk sepsis patients, warranting prospective validation.
葡萄糖钾比值（GPR）正逐渐成为预测各种情况下临床结局的生物标志物。然而，其在入住重症监护病房（ICU）的脓毒症患者中的价值仍不明确。先前的研究结果相互矛盾，一些研究表明GPR有可能作为脓毒症患者代谢失代偿的早期预警指标，而另一些研究则未发现显著关联。本研究通过对ICU脓毒症患者进行首次大规模、系统性的GPR验证，解决了这些不一致性问题。
这项回顾性队列研究使用了MIMIC-IV数据库中的患者记录来检查脓毒症患者的结局。主要结局是30天、60天和90天的医院死亡率和ICU死亡率。使用Kaplan-Meier生存分析、Cox回归模型和受限立方样条（RCS）回归分析评估GPR与这些结局之间的相关性。进行了敏感性分析，包括倾向评分匹配（PSM）、E值量化和亚组分析，以评估研究结果的稳健性。
该研究纳入了9108例脓毒症患者。Kaplan-Meier生存曲线表明，在所有时间点，医院死亡率和ICU死亡率从第一四分位数（Q1）到第四四分位数（Q4）的生存概率逐渐恶化。Cox分析显示，与最低四分位数（Q）的患者相比，GPR最高四分位数（Q4）的患者死亡风险显著增加。确定了GPR与死亡率之间的非线性关系，临界阈值为GPR = 30。亚组分析表明，不同亚组的效应大小和方向是一致的。包括E值量化和倾向评分匹配在内的敏感性分析支持了我们研究结果的稳健性。
本研究表明，较高的GPR水平强烈预测入住ICU的脓毒症患者短期和长期死亡风险增加。GPR的综合性质反映了高血糖和低钾血症，提供了超越单一代谢参数的增量预后价值。在GPR = 30时观察到临界阈值效应，此时风险大幅增加。患者亚组之间的这种一致关联使GPR成为识别高危脓毒症患者的有前景的生物标志物，值得进行前瞻性验证。
