Glucose/potassium ratio as a prognostic marker in the emergency department for multiple trauma patients

Year 2025, Volume: 7 Issue: 5, 602 - 606, 15.09.2025

Osman Lütfi Demirci , Emin Fatih Vişneci

https://doi.org/10.38053/acmj.1752675

Abstract

Aims: This study aimed to evaluate the prognostic value of the glucose-to-potassium ratio (GPR) measured at emergency department (ED) admission in patients with multiple trauma who required intensive care unit (ICU) follow-up.
Methods: This retrospective study was conducted at a tertiary care center between January 1 and December 31, 2022. Adult patients admitted to the ED with multiple trauma and subsequently transferred to the ICU were included. Demographic characteristics, trauma mechanisms, laboratory values, and ICU outcomes were recorded. The predictive value of GPR for ICU mortality was analyzed using receiver operating characteristic (ROC) curve analysis. Additional comparisons were made with established biomarkers such as lactate and injury severity score (ISS).
Results: A total of 253 patients met the inclusion criteria. The most common trauma mechanisms were falls (45.7%) and traffic accidents (38.9%). Median GPR was significantly higher in non-survivors than in survivors [45.5 (30.5–63.6) vs. 31.6 (25.8-39.5), p=0.001]. ROC analysis yielded an area under the curve (AUC) of 0.712 for GPR. The optimal cut-off value was 66.9, with a sensitivity of 21% and specificity of 95%. In logistic regression analysis, GPR was identified as an independent predictor of mortality (p=0.004, Exp (B): 0.96). While lactate (AUC: 0.775) and ISS (AUC: 0.881) showed stronger predictive power, GPR remains a practical and accessible marker in the ED setting.
Conclusion: GPR is a simple, rapid, and cost-effective biomarker that may contribute to early risk stratification in multiple trauma patients. Although it should not be used in isolation for clinical decision-making, it may serve as a valuable adjunct to established prognostic tools. Further prospective and multicenter studies are warranted to validate its clinical utility.

Keywords

Glucose/potassium ratio , multiple trauma , intensive care unit , prognosis

Ethical Statement

The study received ethical clearance from the Ethics Committee of Karatay University School of Medicine (Approval No: 2023/003).

Supporting Institution

Yok

Acil serviste çoklu travma hastalarında prognostik bir belirteç olarak glikoz/potasyum oranı

Abstract

ÖZET
Amaç: Bu çalışma, acil servis (AS) başvurusunda ölçülen glukoz/potasyum oranının (GPR), yoğun bakım ünitesinde (YBÜ) takip gerektiren multipl travmalı hastalardaki prognostik değerini değerlendirmeyi amaçlamıştır.
Yöntem: Bu retrospektif çalışma, 1 Ocak–31 Aralık 2022 tarihleri arasında bir üçüncü basamak sağlık merkezinde yürütülmüştür. Acil servise multipl travma ile başvuran ve ardından YBÜ’ye nakledilen erişkin hastalar çalışmaya dahil edilmiştir. Hastaların demografik özellikleri, travma mekanizmaları, laboratuvar değerleri ve YBÜ sonuçları kaydedilmiştir. GPR’nin YBÜ mortalitesini öngörmedeki değeri, ROC (alıcı işletim karakteristiği) eğrisi analizi ile değerlendirilmiştir. Ek olarak, laktat ve Travma Şiddet Skoru (ISS) gibi sık kullanılan biyobelirteçlerle karşılaştırmalar yapılmıştır.
Bulgular: Çalışma kriterlerini karşılayan toplam 253 hasta analiz edildi. En yaygın travma mekanizmaları düşmeler (%45,7) ve trafik kazaları (%38,9) idi. Medyan GPR, hayatta kalamayan hastalarda hayatta kalanlara göre anlamlı derecede daha yüksekti [45,5 (30,5–63,6) vs. 31,6 (25,8–39,5), p=0,001]. ROC analizi sonucunda GPR için eğri altında kalan alan (AUC) 0,712 olarak bulundu. En uygun eşik değeri 66,9 olup, bu değerde duyarlılık %21 ve özgüllük %95 idi. Lojistik regresyon analizinde GPR, mortalitenin bağımsız bir yordayıcısı olarak belirlendi (p=0,004, Exp(B): 0,96). Laktat (AUC: 0,775) ve ISS (AUC: 0,881) daha güçlü öngörücü performans göstermesine rağmen, GPR acil servis koşullarında pratik ve ulaşılabilir bir belirteç olarak önemini korumaktadır.
Sonuç: GPR, basit, hızlı ve maliyeti düşük bir biyobelirteç olup, multipl travmalı hastalarda erken risk sınıflandırmasına katkı sağlayabilir. Klinik karar verme sürecinde mevcut prognostik araçlara yardımcı bir parametre olarak değerlendirilebilir. Klinik kullanımını doğrulamak amacıyla daha ileri düzeyde prospektif ve çok merkezli çalışmalara ihtiyaç vardır.

Keywords

Glikoz/potasyum oranı , çoklu travma , yoğun bakım , prognoz

References

• Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859):2095 2128. doi:10.1016/S0140 6736(12)61728 0
• Patton GC, Coffey C, Sawyer SM, et al. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet. 2009;374(9693):881 892. doi:10.1016/S0140 6736(09)60741 8
• de Munter L, Polinder S, Lansink KW, Cnossen MC, Steyerberg EW, de Jongh MA. Mortality prediction models in the general trauma population: a systematic review. Injury. 2017;48(2):221 229. doi:10.1016/j.injury.2016.12.009
• Turan E, Şahin A. Role of glucose/potassium ratio and shock index in predicting mortality in patients with isolated thoracoabdominal blunt trauma. Ulus Travma Acil Cerrahi Derg. 2022;28(10):1442 1448. doi:10. 14744/tjtes.2022.15245
• Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187 196. doi:10.1097/00005373 197403000 00001
• Keller WK, Dillihunt RC, Fenner HA, et al. Rating the severity of tissue damage: I. the abbreviated injury scale. JAMA. 1971;215(2):277 280. doi: 10.1001/jama.1971.03180150059012
• Offner PJ, Moore EE, Ciesla D. The adrenal response after severe trauma. Am J Surg. 2002;184(6):649 653. doi:10.1016/S0002 9610(02)01101 7
• Reid JL, Whyte KF, Struthers AD. Epinephrine induced hypokalemia: the role of beta adrenoceptors. Am J Cardiol. 1986;57(12):23F 27F. doi:10. 1016/0002 9149(86)90884 2
• Keel M, Trentz O. Pathophysiology of polytrauma. Injury. 2005;36(6):691 709. doi:10.1016/j.injury.2004.12.037
• Butcher N, Balogh ZJ. The definition of polytrauma: the need for international consensus. Injury. 2009;40(Suppl 4):S12 22. doi:10.1016/j.injury.2009.10.032
• World Health Organization. Guidelines for trauma quality improvement programmes. 2009.
• Altunci YA, Aldemir M, Güloglu C, Üstündag M, Orak M. The effective factors in emergency department observation on hospitalization requirement and mortality in blunt trauma patients. Eurasian J Emerg Med. 2010;9(2):117. doi:10.4170/jaem.2010.42275
• 13. Katipoğlu B, Demirtas E. Assessment of serum glucose potassium ratio as a predictor for morbidity and mortality of blunt abdominal trauma. Turk J Trauma Emerg Surg. 2022;28(2):134. doi:10.14744/tjtes. 2020.88945
• Gary T, Pichler M, Belaj K, et al. Platelet to lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One. 2013;8(7):e67688. doi:10.1371/journal.pone.0067688
• Zahorec R. Ratio of neutrophil to lymphocyte counts—rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5 14.
• Kruip MJ, Leclercq MG, van der Heul C, Prins MH, Büller HR. Diagnostic strategies for excluding pulmonary embolism in clinical outcome studies: a systematic review. Ann Intern Med. 2003;138(12): 941 951. doi:10.7326/0003-4819-138-12-200306170-00005
• Salciccioli JD, Marshall DC, Pimentel MA, et al. The association between the neutrophil to lymphocyte ratio and mortality in critical illness: an observational cohort study. Crit Care. 2015;19(1):13. doi:10. 1186/s13054 014 0731 6