Glucose-to-potassium ratio as a predictor of in-hospital mortality in patients with spontaneous intracranial hemorrhage

Abstract

Background & Objective: Spontaneous intracranial hemorrhage (ICH) is associated with high morbidity and mortality. Early identification of patients at risk for poor outcomes is crucial to guide management and optimize intensive care utilization. Glucose-to-potassium ratio (GPR) is an emerging biomarker that may reflect combined metabolic and systemic derangements. The objective of this study is to evaluate the prognostic performance of GPR in predicting in-hospital mortality among patients with spontaneous ICH.

Methods: In this retrospective observational study, 168 consecutive patients diagnosed with spontaneous ICH between January and December 2024 were included. Demographics, clinical parameters, laboratory results, and interventions were extracted from electronic medical records. The primary outcome was in-hospital mortality. GPR was calculated from admission serum glucose and potassium levels. Statistical analyses included Mann-Whitney U and chi-square tests for group comparisons, receiver operating characteristic (ROC) curve analysis for predictive performance, and multivariable logistic regression to identify independent mortality predictors.

Results: Among 168 patients, 103 (61.3%) survived and 65 (38.7%) died during hospitalization. Non-survivors were older (median 64 vs. 58 years, p = 0.017) and had lower GCS scores (12 vs. 15, p < 0.001). ROC analysis of GPR yielded an area under the curve of 0.718 (95% CI, 0.637–0.800) with an optimal cut-off of ≥37.29, sensitivity of 65.6%, and specificity of 70.8%. In multivariable logistic regression, higher GPR (OR 1.04, 95% CI 1.01–1.07, p = 0.004), older age (OR 1.04, 95% CI 1.01–1.06, p = 0.002), and decompressive craniectomy (OR 3.60, 95% CI 1.52–8.53, p = 0.004) independently predicted in- hospital mortality.

Conclusion: GPR is a simple, cost-effective, and readily obtainable biomarker that independently predicts in-hospital mortality in patients with spontaneous ICH. When combined with established predictors such as age and surgical intervention, GPR may facilitate early risk stratification and guide clinical management. Prospective multicenter studies are warranted to further validate these findings.