The ratio of serum glucose to potassium is associated with poor prognosis in patients with severe acute myocardial infarction

Abstract

The glucose-potassium ratio (GPR) index has been recognized as an early prognostic marker for central nervous system injuries, including aneurysmal subarachnoid hemorrhage and acute intracerebral hemorrhage. Nevertheless, its prognostic significance in critically ill patients suffering from acute myocardial infarction (AMI) who are admitted to the intensive care unit (ICU) has not been thoroughly examined. This study sought to explore the relationship between the GPR index and clinical outcomes in this group of patients. This retrospective cohort study employed data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database to identify critically ill patients with AMI who necessitated admission to the ICU. The patients were categorized into quartiles according to their GPR index levels. The primary outcomes assessed were all-cause mortality at 1 year and at 180 days. To compare survival rates across the four groups, Kaplan-Meier analysis was utilized. Additionally, Cox proportional hazards regression models and restricted cubic spline analyses were performed to investigate the association between the GPR index and clinical outcomes. The study comprised a total of 3811 patients diagnosed with acute myocardial infarction (AMI), of which 70.40% were male. Within this cohort, 999 patients, representing 26.21%, succumbed within one year. Kaplan-Meier analysis indicated a statistically significant elevation in mortality risk among patients exhibiting increased GPR indices (log-rank P < 0.001). Furthermore, restricted cubic spline analysis demonstrated a non-linear escalation in the risk of all-cause mortality corresponding to rising GPR indices (P for nonlinearity < 0.001). Multivariate Cox proportional hazards analysis revealed that individuals in the highest quartile of GPR indices faced a markedly increased risk of 1-year all-cause mortality when compared to those in the lowest quartile [HR 1.70; 95% CI (1.40-2.07); P < 0.001]. Consistent patterns were noted in the assessment of 180-day all-cause mortality. In patients with acute myocardial infarction (AMI) who are critically ill, an elevated GPR index correlates with a heightened risk of all-cause mortality at both 1 year and 180 days. These results indicate that the GPR index could be an important instrument for the identification of high-risk individuals with AMI.

Fig. 1

Flowchart of patient selection.

Fig. 2

(A) 1-year KM survival curve; (B) 180-day KM survival curve.

Fig. 3

(A) Results of one-year all-cause mortality from RCS analysis, (B) Results of 180-day all-cause mortality from RCS analysis. Results of 180-day all-cause mortality from restricted cubic spline (RCS) analysis. The horizontal dashed line represents a hazard ratio of 1.0. HR hazard ratio; CI confidence interval.

Fig. 4

The ROC curve was used to evaluate the predictive ability of the GPR index for 1 year all—cause mortality.

Fig. 5

(A) Subgroup analysis of the association between the GPR and 1-year all-cause mortality, (B) Subgroup analysis of the association between the GPR and 180-day all-cause mortality. Adjusted for age, sex, BMI, race, tobacco use, hypertension, HF, stroke, ARF, CKD, diabetes, cardiogenic shock, revascularization status, potassium, chloride, GLU, AG, WBC, red blood cell count, PLT, Hb, RDW, HCT, PT, APTT, BUN, and Cr, excluding the subgroup factors themselves.