Prognostic value of glucose-to-lymphocyte ratio in critically ill patients with acute respiratory distress syndrome: A retrospective cohort study

Predictive value of hematologic indices on weaning from mechanical ventilation and 30-day mortality in patients with traumatic brain injury in an intensive care unit: A retrospective analysis of MIMIC-IV data

The management of traumatic brain injury (TBI) in intensive care units is dependent on the wise use of life-support systems. This study investigated the utility of various hematologic indices to predict successful weaning and risk of short-term mortality in TBI patients. Data of patients with TBI requiring mechanical ventilation were extracted from the MIMIC-IV database and retrospectively reviewed. Successful weaning was defined as no re-intubation or death within 48 ​h, non-invasive ventilation under 48 ​h post-extubation, and passing a spontaneous breathing test with specific respiratory and cardiovascular stability criteria. The systemic inflammatory response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and glucose-to-lymphocyte ratio (GLR) were evaluated for their predictive value using logistic regression and receiver operating characteristic (ROC) analyses. A total of 414 patients were included. After adjustment, higher PLR and GLR (adjusted odds ratio [aOR] ​= ​0.766, 95 ​% confidence interval [CI]: 0.66-0.89) and GLR (aOR ​= ​0.761, 95 ​% CI: 0.65-0.89) were significantly associated with a lower likelihood of weaning success, while higher NLR (aOR ​= ​1.70, 95 ​% CI: 1.18-2.45) was associated with increased 30-day mortality. The area under the ROC curve (AUC) values for predicting weaning success were 0.636 for PLR and 0.634 for GLR. NLR showed good predictive accuracy for 30-day mortality with an AUC ​= ​0.752. In conclusions, in patients with TBI, PLR, GLR, and NLR may serve as predictors of mechanical ventilation weaning success and 30-day mortality.

Early Predictive Value of the Glucose-to-Lymphocyte Ratio for the Occurrence of Stroke-Associated Pneumonia

BACKGROUND AND OBJECTIVE

Hyperglycemia and poststroke immunosuppression can lead to a decline in immune function, resulting in an increased incidence of infectious events. The relationship between the glucose-to-lymphocyte ratio (GLR), a novel indicator, and stroke-associated pneumonia (SAP) remains unclear. The objective of this study is to investigate the early predictive value of the GLR in the context of SAP.

METHODS

A retrospective analysis was conducted on acute stroke patients admitted to the Department of Neurology at the First Affiliated Hospital of Kunming Medical University from 2017 to 2021. The dataset included demographic information, vascular risk factors, and laboratory test results. Logistic regression analysis was used to assess the correlation between the GLR and the incidence of SAP. The GLR was converted into a categorical variable for trend testing, and compared the predictive efficiency of GLR through the receiver operating characteristic (ROC) curve and Bonferroni correction analysis.

RESULTS

This study included 711 patients with acute stroke according to a 1:2 case-control ratio, with 237 (33.3%) in the SAP group and 474 (66.7%) in the Non-SAP group. The baseline level of the GLR was significantly greater in the SAP group than in the Non-SAP group (p < 0.001). After correction using multifactorial logistic regression analysis, GLR (OR: 1.182, 95% CI: 1.090-1.281, p < 0.001) was identified as an independent risk factor for SAP. When GLR was converted into a categorical variable, the risk of SAP in group Q3 was 3.210 times greater than that in group Q1, and the trend test yielded p < 0.001. The analysis of the ROC curve revealed that the area under the curve (AUC) for the GLR was 0.737, with a sensitivity of 70.0% and specificity of 67.1% at a cutoff value of 4.110. The predictive efficacy of the GLR for SAP patients was superior to that of either blood glucose or lymphocyte counts alone (p < 0.0167).

CONCLUSIONS

An elevated GLR within 24 h of hospital admission following an acute stroke is an independent risk factor for SAP. The risk of SAP increases progressively with increasing GLR, suggesting that the GLR may have a certain early predictive value for the occurrence of SAP.

Relationship between glucose to lymphocyte ratio and the first peritonitis episode in patients treated with peritoneal dialysis

This study aimed to investigate the potential relationship between baseline glucose to lymphocyte ratio (GLR) levels and the first episode of peritonitis in patients treated with peritoneal dialysis (PD). A total of 314 patients treated with PD were included and divided into three groups based on GLR tertiles: tertile 1 (GLR ≤ 4.23); tertile 2 (4.23 < GLR ≤ 5.96), and tertile 3 (GLR > 5.96). The relationships between GLR and the first peritonitis episode were analyzed using Kaplan-Meier curves and multivariable Cox regression models. Competitive risk analysis, subgroup and sensitivity analyses were performed to validate the robustness of the findings. During a median follow-up of 27 months, 123 (39.17%) patients developed the first episode of peritonitis. The incidence of the first peritonitis episode increased with the higher GLR tertiles (tertile 1: 32.08%, tertile 2: 37.50%, tertile 3: 48.08%). Kaplan-Meier curves revealed significant differences in the cumulative incidence of the first peritonitis episode among the GLR tertiles (Log-Rank test, P = 0.018). After full adjustment for confounding factors, patients in tertile 3 remained at significantly higher risk for the first episode of peritonitis compared to those in tertile 1 (HR 2.633, 95% CI 1.223-5.668, P = 0.013). Competitive risk models and sensitivity analysis further confirmed this association. Our study suggests that elevated GLR is associated with an increased risk of the first peritonitis episode in patients with PD.

Association of glucose to lymphocyte ratio with the risk of death in patients with atherosclerotic cardiovascular disease

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of mortality worldwide. Dysregulation of glucose metabolism and inflammation are key factors in the development of atherosclerosis. The glucose-to-lymphocyte ratio (GLR) is a comprehensive marker for assessing glucose metabolism and inflammation. This study aims to evaluate the association between GLR and all-cause as well as cardiovascular disease (CVD) mortality in patients with ASCVD within the U.S. population. This retrospective cohort study recruited 1,753 ASCVD patients from the 2003-2018 National Health and Nutrition Examination Survey (NHANES) with a median follow-up of 6.25 years. Mortality outcomes were determined by linkage to the National Death Index (NDI) records up to December 31, 2019. Weighted Cox proportional hazard models were used to assess the independent association between GLR and mortality risk. Restricted cubic spline (RCS) curves were used to display the relationship between GLR and all-cause mortality visually, and two-segment Cox proportional hazards models were constructed on either side of the inflection points. Kaplan-Meier survival curves were further used to assess the relationship between GLR and mortality, and further subgroup analyses were performed. Receiver operating characteristic curve (ROC) analysis was conducted to assess the predictive ability of GLR for survival. During a median follow-up of 6.25 years, 624 deaths from various causes were observed, with 254 deaths from CVD. Cox regression analysis revealed a positive association between GLR and both all-cause and CVD mortality. Based on RCS, a J-shaped nonlinear relationship was observed between GLR and all-cause mortality in ASCVD patients, with an inflection point at 3.13. When the GLR < 3.13, it showed a significant negative association with all-cause mortality (HR 0.65, 95% CI 0.47-0.89). When GLR ≥ 3.13 for all-cause mortality, there was a significant positive correlation with all-cause mortality (HR 1.13, 95% CI 1.09-1.17). Subgroup analysis revealed a positive association between GLR and CVD mortality across most subgroups, but the correlation between GLR and CVD mortality was weaker compared to its association with all-cause mortality. In addition, an interaction was detected between GLR and age in relation to all-cause mortality. Moreover, the predictive performance of GLR on all-cause and CVD mortality seemed superior to that of glucose or lymphocytes. Our findings indicate that elevated GLR was closely associated with an increased risk of all-cause mortality and CVD mortality in ASCVD patients. Notably, the relationship between GLR and all-cause mortality exhibited a J-shaped nonlinear pattern, with an inflection point at 3.13.

Association between glucose to lymphocyte ratio and prognosis in patients with solid tumors

Background

Glucose-to-lymphocyte ratio (GLR) plays an important role in the prognosis of various tumors. The aim of this study was to comprehensively evaluate the prognostic value of GLR in solid tumors through the meta-analysis.

Methods

A comprehensive search of eligible studies was performed by scrutinizing the Pubmed, Embase and Web of science databases until May 30, 2024. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to evaluate overall survival (OS), disease-free survival (DFS) and recurrence free survival (RFS).

Results

A total of 22 studies from 14 articles involving 9472 patients were included in the study. The pooled analysis showed that cancer patients with high GLR was significantly associated with unfavorable OS (HR:1.48,95% CI:1.34-1.63) and DFS/RFS (HR:2.20,95% CI:1.66-2.92). Subgroup analysis further showed that high GLR had better predictive value in liver cancer (HR:2.66, 95%CI:1.80-3.93), breast cancer (HR:2.13, 95%CI:1.10-4.13) and pancreatic cancer (HR:1.92, 95%CI:1.30-2.84).

Conclusions

GLR can be used as an effective prognostic marker in patients with solid tumors.

Effects of acetaminophen use on mortality of patients with acute respiratory distress syndrome: secondary data mining based on the MIMIC-IV database

BACKGROUND

Acetaminophen is a commonly used analgesic after surgery, and its impact on prognosis in patients with acute respiratory distress syndrome (ARDS) has not been studied. This study explores the association between the use of acetaminophen and the risk of mortality in patients with ARDS.

METHODS

In this retrospective cohort study, 3,227 patients with ARDS who had or had not received acetaminophen were obtained from the Medical Information Mart for Intensive Care IV, patients were divided into acetaminophen and non- acetaminophen groups. In-hospital mortality of ARDS patients was considered as primary end point. We used univariate and multivariate Cox regression analyses to assess the relationship of acetaminophen use and in-hospital mortality in patients with ARDS. Subgroup analysis was performed according to age, gender, and severity of ARDS.

RESULTS

Of the total patients, 2,438 individuals were identified as acetaminophen users. The median duration of follow-up was 10.54 (5.57, 18.82) days. The results showed that the acetaminophen use was associated with a decreased risk of in-hospital mortality [hazard ratio (HR) = 0.67, 95% confidence interval (CI): 0.57-0.78]. Across various subgroups of patients with ARDS based on age, gender, and severity, acetaminophen use exhibited an association with reduced risk of in-hospital mortality.

CONCLUSION

Acetaminophen use was associated with in-hospital mortality of patients with ARDS. Acetaminophen therapy may represent a promising therapeutic option for ARDS patients and warrants further investigation.

Low Prognostic Nutritional Index (PNI) Level is Associated with an Increased Risk of Neonatal Respiratory Distress Syndrome in Preterm Infants with Different Gestational Ages: A Retrospective Study

Background

Neonatal respiratory distress syndrome (NRDS) is common in preterm infants. Prognostic nutritional index (PNI)((albumin (g/L)+(5×total lymphocyte count (109/L)) is a comprehensive indicator of nutritional and immune levels, and associated with several diseases. The relationship between PNI and the risk of NRDS in newborns of different gestational ages remains unclear.

Methods

A total of 2722 preterm infants were included in this retrospective study. PNI level and clinical records of these neonates (adverse pregnancy and birth history, amniotic fluid contamination, nuchal cord, placental abnormality, mode of delivery, gender and birth weight of neonates, Apgar scores) were collected. The clinical features of the infants with and without NRDS were compared. Logistic regression analysis was used to evaluate the relationship between PNI and NRDS in newborns with different gestational ages.

Results

There were 1226 neonates with NRDS and 1496 without NRDS. The differences in the proportions of placenta abnormality, cesarean section, and small for gestational age (SGA) among infants with 34-37 weeks, 28+1-33+6 weeks, and ≤28 weeks gestational age were statistically significant. Logistic analysis showed that cesarean section (odds ratio (OR): 1.550, 95% confidence interval (CI): 1.197-2.007, p=0.001), and low PNI (OR: 1.417, 95% CI: 1.110-1.808, p=0.005) were associated with NRDS in infants born at 34-37 weeks gestational. Adverse pregnancy and birth history (OR: 1.507, 95% CI: 1.124-2.019, p=0.006), SGA (OR: 1.994, 95% CI: 1.455-2.733, p<0.001), and low PNI (OR: 1.626, 95% CI: 1.230-2.149, p=0.001) were associated with NRDS in infants with 28+1-33+6 weeks gestational age. Low PNI (OR: 5.512, 95% CI: 1.555-19.536, p=0.008) was associated with NRDS in infants with ≤28 weeks gestational age.

Conclusion

The risk factors for NRDS in preterm infants with different gestational ages were different. But the low PNI level is associated with an increased risk of NRDS in preterm infants with all different gestational ages.

The Role of Glucose-Lymphocyte Ratio in Evaluating the Severity of Coronary Artery Disease

Background: Recently, a new inflammatory and prognostic marker called glucose/lymphocyte ratio (GLR) has been used in patients with coronary artery disease. In this study, we analyzed the correlation between GLR and coronary artery disease (CAD) severity in patients with chronic coronary syndrome (CCS). Methods: The study included 341 patients with CCS who underwent coronary angiography and documented coronary stenosis of 50% or more in at least one major coronary artery and 437 individuals with coronary atherosclerosis between 1% and 50% or no coronary atherosclerosis (control group). Blood samples for GLR and other laboratory parameters were obtained from all patients on admission. GLR was obtained by dividing the glucose level by the lymphocyte count. Results: There were more patients with diabetes mellitus (DM) in the critical CAD group, and glucose levels (p < 0.001), neutrophil counts (p < 0.001), C-reactive protein (CRP) levels (p < 0.001), neutrophil/lymphocyte ratio (NLR) (p < 0.001), platelet/lymphocyte ratio (PLR) (p < 0.001), and GLR (p < 0.001) were higher. In contrast, lymphocyte counts were lower (p < 0.034). Multivariate logistic regression analysis showed that DM and high CRP were independent predictors of critical CAD (p = 0.004 and p = 0.048, respectively). However, high GLR was found to be an independent predictor of critical CAD (p < 0.001). Conclusions: GLR, a simple and easily measured marker, has shown strong predictive value for CAD severity in CCS patients.

Association of coagulation function with the risk of in-hospital mortality in patients with severe acute respiratory distress syndrome

BACKGROUND

To evaluate the association of coagulation disorder score with the risk of in-hospital mortality in acute respiratory distress syndrome (ARDS) patients.

METHODS

In this cohort study, 7,001 adult patients with ARDS were identified from the Medical Information Mart for Intensive Care Database-IV (MIMIC-IV). Univariate and multivariate Logistic stepwise regression models were used to explore the associations of coagulation-associated biomarkers with the risk of in-hospital mortality in patients with ADRS. Restricted cubic spline (RCS) was plotted to explore the association between coagulation disorder score and in-hospital mortality of ARDS patients.

RESULTS

The follow-up time for in-hospital death was 7.15 (4.62, 13.88) days. There were 1,187 patients died and 5,814 people survived in hospital. After adjusting for confounding factors, increased risk of in-hospital mortality in ARDS patients was observed in those with median coagulation disorder score [odds ratio (OR) = 1.22, 95% confidence interval (CI): 1.01-1.47) and high coagulation disorder score (OR = 1.38, 95% CI: 1.06-1.80). The results of RCS indicated that when the coagulation disorder score >2, the trend of in-hospital mortality rose gradually, and OR was >1.

CONCLUSIONS

Poor coagulation function was associated with increased risk of in-hospital mortality in ARDS patients. The findings implied that clinicians should regularly detect the levels of coagulation-associated biomarkers for the management of ARDS patients.

Prognostic value of lactic dehydrogenase-to-albumin ratio in critically ill patients with acute respiratory distress syndrome: a retrospective cohort study

Background

Lactic dehydrogenase (LDH)-to-albumin ratio (LAR) was an independent risk factor for mortality in the patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19), while the relationship among LAR and short-term, long-term, in-hospital mortalities of ARDS remains unclear. The current study aims to investigate the association between LAR and significant prognosis in patients with ARDS.

Methods

We conducted a retrospective cohort study and analyzed patients with ARDS on the Medical Information Mart for Intensive Care IV (MIMIC-IV) version 2.0 database. In the current study, 30-day mortality was defined as the primary outcome; 90-day mortality and in-hospital mortality were defined as secondary outcomes. Multivariate regression analysis, Kaplan-Meier curve analysis and subgroup analysis were performed to research the association between LAR and prognosis in patients with ARDS.

Results

A total of 358 critically ill patients with ARDS were enrolled in the current study. The mean age of the participants was 62.6±16.0 and the median of LAR was 14.3. According to the Kaplan-Meier curve analysis, the higher LAR group had a higher 30-day, 90-day and in-hospital mortalities. We also analyzed the 30-day mortality to receiver operating characteristic (ROC) curves by comparing the value between LAR and LAR + simplified acute physiology score II (SAPS II). The area under the curve (AUC) of the LAR group was 0.694 [95% confidence interval (CI): 0.634-0.754, P<0.001], and 0.661 for the LAR + SAPS II (95% CI: 0.599-0.722, P<0.001). For 30-day mortality, after adjusting for covariates, hazard ratios (HRs) (95% CIs) for tertile 2 (LAR 8.7-30.9) and tertile 3 (LAR >30.9) were 2.00 (1.37, 2.92) and 2.50 (1.50, 4.15), respectively. Similar results were also observed for 90-day mortality and in-hospital mortality.

Conclusions

Elevated LAR levels are associated with increased 30- and 90-day mortalities, as well as in-hospital mortality in patients with ARDS, which means LAR levels may predict the mortalities of ARDS patients.

Association between glucose-to-lymphocyte ratio and in-hospital mortality in acute myocardial infarction patients

BACKGROUND

Inflammation is involved in the development and progression of atherosclerosis. Recent studies indicated that glucose-to-lymphocyte ratio (GLR) level were significantly associated with the risk of mortality from inflammatory diseases, and showed a specific prognostic value. Herein, this study intended to explore the association between GLR level and in-hospital mortality in patients with acute myocardial infarction (AMI), and evaluate the predictive value of GLR on AMI prognosis.

METHODS

Data of patients with AMI were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database in 2012-2019 in this retrospective cohort study. Univariate COX proportional hazard model was used to screen covariates. The associations between GLR and in-hospital mortality were evaluated using univariate and multivariate COX proportional hazard models. Subgroup analysis of age, gender, vasopressor use, SOFA scores, renal replacement therapy, coronary artery bypass graft, and β blockers use were performed. The evaluated index was hazard ratios (HRs) and 95% confidence intervals (CIs). In addition, the predictive performance of GLR, glucose, and lymphocytes on in-hospital mortality was assessed respectively.

RESULTS

Among eligible patients, 248 (13.74%) died in the hospital. After adjusting for covariates, we found that a higher GLR level was associated with an increased risk of in-hospital mortality [HR = 1.70, 95%CI: (1.24-2.34)]. This relationship was also found in patients who were male, aged ≥65 years old, did not have renal replacement therapy, coronary artery bypass graft, or β blockers, used vasopressor or not, and whatever the SOFA scores (all P<0.05). Moreover, the predictive performance of GLR on in-hospital mortality seemed superior to that of glucose or lymphocytes.

CONCLUSION

GLR may be a potential predictor for AMI prognosis, which provided some references for identifying and managing high-risk populations early in clinical.