{
  "abstract": "Background: Traumatic brain injury (TBI) is a major cause of death and disability. The glucose-to-potassium ratio (GPR), or stress index (SI), reflects stress hyperglycemia and hypokalemia and may improve early prognostication beyond clinical and radiologic scores.\n\nMethods: We performed a PRISMA-guided systematic review and meta-analysis of observational cohort studies in adults (≥18 years) with CT-confirmed TBI reporting admission glucose and potassium and their association with mortality or functional/“poor outcome.” Random-effects models pooled odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) for continuous GPR values; heterogeneity was assessed with I ² . Prespecified subgroup analyses were conducted by sample size (>500 vs. < 500), with sensitivity analyses (leave-one-out; fixed vs. random) and funnel-plot inspection to explore robustness and small-study effects.\n\nResults: Three studies (4,550 patients) contributed to the primary comparison of high versus low GPR and mortality. High GPR was associated with increased odds of death (pooled OR 11.97, 95% CI 2.68–53.37; p = 0.001; I ² = 88%). Across four studies, patients with poor outcomes had higher admission GPR than those with good outcomes (pooled MD 16.82, 95% CI 12.70–20.94; p < 0.00001; I ² = 61%). In five studies evaluating GPR as a prognostic predictor, the pooled adjusted OR for adverse outcome was 2.10 (95% CI 1.51–2.93; p < 0.0001; I ² = 37%). Effects were larger in small single-center cohorts and more moderate, but significant, in the large registry-based study; sample size explained much of the between-study heterogeneity. Funnel-plot asymmetry suggested possible small-study effects/publication bias.\n\nConclusion: Elevated admission GPR/SI is associated with increased mortality and poor outcome in adult TBI and may capture early systemic stress. As a bedside metric derived from routine laboratory tests, it is a promising adjunct for early risk stratification. However, heterogeneity, small-study effects, and observational evidence warrant cautious interpretation; large multicenter prospective studies are needed to validate standardized thresholds and incremental value over existing prognostic models.",
  "abstract_shown": true,
  "affiliations": [
    "Quaid-e-Azam Medical College , ,",
    "Sukrajaj Hospital of Tropical and Infectious Disease , ,"
  ],
  "article_type": "systematic review",
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Mesum Abbas"
    },
    {
      "affs": [
        0
      ],
      "name": "Muhammad Moin-Ud-Din Arshad"
    },
    {
      "affs": [
        0
      ],
      "name": "Ali Sher"
    },
    {
      "affs": [
        0
      ],
      "name": "Rimsha Maqsood"
    },
    {
      "affs": [
        0
      ],
      "name": "Muhammad Bilal Akram"
    },
    {
      "affs": [
        0
      ],
      "name": "Areena Fatima"
    },
    {
      "affs": [
        0
      ],
      "name": "Sadat Ali"
    },
    {
      "affs": [
        0
      ],
      "name": "Waqar Ali Shah"
    },
    {
      "affs": [
        0
      ],
      "name": "Muhammad Anees"
    },
    {
      "affs": [
        0
      ],
      "name": "Abdullah Faramarz"
    },
    {
      "affs": [
        0
      ],
      "name": "Abdur Rehman"
    },
    {
      "affs": [
        0
      ],
      "name": "Muhammad Abdullah Masood"
    },
    {
      "affs": [
        1
      ],
      "name": "Amit Kumar Thakur"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/38zskrkk340vs.bib",
  "cited_by": 0,
  "doi": "10.3389/fneur.2026.1848006",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668550/?tool=EBI",
  "id": "38zskrkk340vs",
  "issns": [
    "1664-2295"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13668550",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2728|Traumatic Brain Injury and Neurovascular Disturbances"
    ]
  ],
  "openalex": "W7215086378",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668550/pdf/?tool=EBI",
  "pmcid": "PMC13668550",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/38zskrkk340vs.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:25Z",
      "native_id": "PMC:PMC13668550",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13668550"
    },
    {
      "first_seen": "2026-10-30T12:20:16Z",
      "native_id": "10.3389/fneur.2026.1848006",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fneur.2026.1848006/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2728|Traumatic Brain Injury and Neurovascular Disturbances",
      "subfield": "neurology"
    }
  ],
  "title": "Stress index (glucose-to-potassium ratio) as a predictor of outcome in traumatic brain injury: systematic review and meta-analysis",
  "title_text": "Stress index (glucose-to-potassium ratio) as a predictor of outcome in traumatic brain injury: systematic review and meta-analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:16Z",
  "url": "https://research.draconitic.com/paper/38zskrkk340vs",
  "venue": "Frontiers in neurology",
  "versions": []
}