Assessment of serum glucose potassium ratio as a predictor for mortality of acute ischemic stroke

Öz

Aim: The study aims to demonstrate the effect of changes in serum glucose/potassium ratio (GPR) which were performed in patients with acute ischemic stroke (AIS) and patient management is performed more quickly and effectively. Material and Methods: The hemogram and biochemical parameters of patients undergoing mechanical thrombectomy (MT) for AIS have been retrospectively reviewed. Patients were divided into two groups non-survivors and survivors. The GPR was calculated, and their ability to predict mortality was statistically evaluated between the groups. Results: A total of 173 patients, of which 131 in the survivor group and 42 in the non-survivor group, were examined. In the non-survivor group Glucose and GPR were statistically higher than the survivor group (p<0.05). Moreover, the sensitivity and specificity of the serum GPR were found to be 97.6% and 50.4%, respectively. Conclusion: These findings suggest that GPR could serve as a useful parameter for predicting mortality in AIS patients undergoing mechanical thrombectomy.

Anahtar Kelimeler

• glucose-potassium ratio
• acute ischemic stroke
• mortality
• mechanical thrombectomy

Akut iskemik inme mortalitesinin bir belirleyicisi olarak serum glukoz potasyum oranının değerlendirilmesi

Öz

Amaç: Bu çalışma, akut iskemik inme (AIS) hastalarında yapılan serum glukoz/potasyum oranındaki (GPR) değişikliklerin hasta yönetiminin daha hızlı ve etkin bir şekilde yapılmasına etkisini göstermeyi amaçlamaktadır. Gereç ve Yöntemler: AIS nedeniyle mekanik trombektomi uygulanan hastaların hematolojik ve biyokimyasal parametreleri retrospektif olarak incelendi. Hastalar non-survivor (yaşamayanlar) ve survivor (yaşayanlar) olmak üzere iki gruba ayrıldı. GPR hesaplandı ve mortaliteyi tahmin etme yetenekleri gruplar arasında istatistiksel olarak değerlendirildi. Bulgular: Survivor grupta 131 ve non-survivor grupta 42 olmak üzere toplam 173 hasta analiz edildi. Non-survivor grubunda glukoz ve GPR, survivor grubuna göre istatistiksel olarak anlamlı şekilde yüksekti (p<0.05). Ayrıca, serum GPR'nin duyarlılığı ve özgüllüğü sırasıyla %97.6 ve %50.4 olarak bulundu. Sonuç: Bu bulgular, mekanik trombektomi uygulanan AIS hastalarında mortaliteyi tahmin etmek için GPR'nin kullanışlı bir parametre olarak hizmet edebileceğini öne sürmektedir.

Anahtar Kelimeler

• glukoz-potasyum oranı
• akut iskemik inme
• mortalite
• mekanik trombektomi

Kaynakça

1. Phipps MS, Cronin CA. Management of acute ischemic stroke. J Bmj. 2020;368.
2. Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. J n Engl J Med. 2015;372:11-20.
3. Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. J New England Journal of Medicine. 2015;372(11):1019-30.
4. Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. J New England Journal of Medicine. 2015;372(24):2285-95.
5. Ozdemir O, Giray S, Arlier Z, Baş DF, Inanc Y, Colak E. Predictors of a good outcome after endovascular stroke treatment with stent retrievers. J The Scientific World Journal. 2015;2015.
6. Son S, Kang D-H, Hwang Y-H, Kim Y-S, Kim Y-W. Efficacy, safety, and clinical outcome of modern mechanical thrombectomy in elderly patients with acute ischemic stroke. J Acta Neurochirurgica. 2017;159:1663-9.
7. Wu X-Y, Zhuang Y-K, Cai Y, et al. Serum glucose and potassium ratio as a predictive factor for prognosis of acute intracerebral hemorrhage. Journal of International Medical Research. 2021;49(4):03000605211009689.
8. Boyuk F. The predictor potential role of the glucose to potassium ratio in the diagnostic differentiation of massive and non-massive pulmonary embolism. J Clinical Applied Thrombosis/Hemostasis 2022;28:10760296221076146.

9. Katipoğlu B, Demirtaş E. Assessment of serum glucose potassium ratio as a predictor for morbidity and mortality of blunt abdominal trauma. J Turkish Journal of Trauma Emergency Surgery 2022;28(2):134.
10. Jung HM, Paik JH, Kim SY, Hong DY. Association of plasma glucose to potassium ratio and mortality after aneurysmal subarachnoid hemorrhage. J Frontiers in Neurology. 2021;12:661689.
11. Shibata A, Matano F, Saito N, et al. Serum glucose-to-potassium ratio as a prognostic predictor for severe traumatic brain injury. J Journal of Nippon Medical School. 2021;88(4):342-6.
12. Leng X, Fang H, Leung TW, et al. Impact of collaterals on the efficacy and safety of endovascular treatment in acute ischaemic stroke: a systematic review and meta-analysis. J Journal of Neurology, Neurosurgery Psychiatry 2016;87(5):537-44.
13. Wufuer A, Wubuli A, Mijiti P, et al. Impact of collateral circulation status on favorable outcomes in thrombolysis treatment: a systematic review and meta-analysis. J Experimental therapeutic medicine 2018;15(1):707-18.
14. van Horn N, Kniep H, Leischner H, et al. Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients. J Journal of NeuroInterventional Surgery. 2021;13(1):14-8.
15. Kim J-T, Jahan R, Saver JL, Investigators S. Impact of glucose on outcomes in patients treated with mechanical thrombectomy: a post hoc analysis of the solitaire flow restoration with the intention for thrombectomy study. J Stroke. 2016;47(1):120-7.
16. Šaňák D, Černík D, Divišová P, et al. Low levels of glycemia within the first 48 hours after mechanical thrombectomy for acute ischemic stroke may be associated with better clinical outcome. J Journal of Stroke Cerebrovascular Diseases 2020;29(4):104621.
17. Bessey PQ, Watters JM, Aoki TT, Wilmore DW. Combined hormonal infusion simulates the metabolic response to injury. J Annals of surgery. 1984;200(3):264.
18. Van Donkelaar CE, Dijkland SA, Van Den Bergh WM, et al. Early circulating lactate and glucose levels after aneurysmal subarachnoid hemorrhage correlate with poor outcome and delayed cerebral ischemia: a two-center cohort study. J Critical care medicine. 2016;44(5):966-72.
19. Reid JL, Whyte KF, Struthers AD. Epinephrine-induced hypokalemia: the role of beta adrenoceptors. J The American Journal of Cardiology. 1986;57(12):F23-F7.
20. Massara F, Tripodina A, Rotunno M. Propranolol block of epinephrine-induced hypokaliaemia in man. J European Journal of Pharmacology. 1970;10(3):404-7.
21. Zhou J, Yang C-S, Shen L-J, Lv Q-W, Xu Q-C. Usefulness of serum glucose and potassium ratio as a predictor for 30-day death among patients with severe traumatic brain injury. J Clinica Chimica Acta. 2020;506:166-71.
22. Wu X, Lu X, Lu X, et al. Prevalence of severe hypokalaemia in patients with traumatic brain injury. J Injury. 2015;46(1):35-41.
23. McCowen KC, Malhotra A, Bistrian BR. Stress-induced hyperglycemia. J Critical care clinics. 2001;17(1):107-24.
24. Leto R. Response to Li and colleagues on hyperglycemia in hip fracture patients. J European Journal of Emergency Medicine. 2015;22(4):294-6.
25. Yendamuri S, Fulda GJ, Tinkoff GH. Admission hyperglycemia as a prognostic indicator in trauma. J Journal of Trauma Acute Care Surgery 2003;55(1):33-8.
26. Fujiki Y, Matano F, Mizunari T, et al. Serum glucose/potassium ratio as a clinical risk factor for aneurysmal subarachnoid hemorrhage. J Journal of neurosurgery. 2017;129(4):870-5.
27. Jung, Hyun Min, et al. Association of plasma glucose to potassium ratio and mortality after aneurysmal subarachnoid hemorrhage. Frontiers in Neurology, 2021; 12: 661-689