Glucose-to-platelet ratio: a potential predictor of short-term functional outcome in patients with acute ischemic stroke

Abstract

Background: Glucose and platelets are two important indicators that are readily available in the emergency setting. The glucose-to-platelet (G/P) ratio appears to be important for hemorrhagic transformation in patients with acute ischemic stroke (AIS). However, its role in functional outcome remains unclear. Objective: To evaluate the association between G/P at admission and functional outcomes, as well as mortality, in patients with AIS. Methods: This prospective cohort study was conducted from July 2023 to March 2026 and included patients aged ≥ 18 years admitted to an intensive care unit with a diagnosis of AIS. The primary endpoint was a poor functional outcome at 90 days, defined as a modified Rankin Scale (mRS) score ≥ 3. To evaluate the association between G/P and outcomes, univariate and multivariable logistic regression analyses were performed. The model was adjusted for age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, and receipt of thrombolytic therapy. Platelets were counted in groups of 10,000 for the G/P calculation. Odds Ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results: A total of 719 patients were included in the analysis. The mean age was 65.8 ± 13 years, 51.7% were male, 77% had hypertension, 35.5% had diabetes, and the mean baseline NIHSS score was 8.8 ± 5.6. In the univariate analysis, G/P was not associated with in-hospital mortality (p=0.353) or poor functional outcome at 90 days (p=0.082), but was associated with an unfavorable functional outcome at 30 days (OR 1.063; 95% CI 1.013-1.116; p=0.013). In the multivariable analysis, G/P remained independently associated with a poor functional outcome at 30 days (OR 1.060; 95% CI 1.007-1.117; p=0.027), whereas in-hospital mortality (p=0.908) and poor functional outcome at 90 days (p=0.142) were not associated. Conclusion: A higher G/P at admission was independently associated with a poor functional outcome at 30 days in patients with AIS, but not with in-hospital mortality or poor functional outcome at 90 days. These findings suggest that G/P may be a useful short-term functional prognostic marker in this population. Identification of these two clinical factors may help guide treatment and monitor patient progression.