Association between the Glucose-to-Lymphocyte Ratio and Mortality in Patients with Ischemic Stroke: Based on the...

Ischemic stroke (IS) is a major global public health problem with high rates of mortality and disability. The glucose-to-lymphocyte ratio (GLR), an inflammatory marker reflecting metabolic and immune status, has recently attracted attention for prognostication in several diseases. However, its relationship with short-term mortality in IS patients remains unclear. This study investigates the association between GLR and 28-day all-cause mortality in IS patients.

A retrospective cohort study was conducted using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Cox proportional-hazards regression, restricted cubic spline (RCS) analysis, Kaplan-Meier (K-M) survival curves, and stratified interaction analyses were used to elucidate the relationship between GLR and clinical outcomes. Mediation analysis was performed to evaluate whether heart rate mediates the GLR-mortality association.

A total of 1,307 patients were included. K-M curves revealed significantly lower 28-day survival in the high-GLR group (≥4.918) ( P < 0.001). Fully adjusted Cox regression showed that GLR was positively associated with 28-day mortality (hazard ratio [HR] = 1.338, 95% confidence interval [CI]: 1.115-1.604, P = 0.002). RCS analysis found no significant non-linear relationship ( Pnon-linear = 0.308). Subgroup analysis showed more significant association in patients who did not receive invasive ventilation (HR = 2.281, Pinteraction < 0.001). Mediation analysis indicated that heart rate partially mediated the GLR-mortality pathway, with a mediation proportion of 9.82% ( P = 0.030).

Elevated GLR is significantly associated with increased 28-day all-cause mortality in IS patients, suggesting that GLR serves as a readily available biomarker for short-term risk stratification and clinical management for IS.