Stress index (glucose-to-potassium ratio) as a predictor of outcome in traumatic brain injury: systematic review and meta-analysis
- 1Quaid-e-Azam Medical College , ,
- 2Sukrajaj Hospital of Tropical and Infectious Disease , ,
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.
Methods: 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.
Results: 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.
Conclusion: 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.
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BibTeX
@article{abbas2026stress,
title = {{Stress index (glucose-to-potassium ratio) as a predictor of outcome in traumatic brain injury: systematic review and meta-analysis}},
author = {Mesum Abbas and Muhammad Moin-Ud-Din Arshad and Ali Sher and Rimsha Maqsood and Muhammad Bilal Akram and Areena Fatima and Sadat Ali and Waqar Ali Shah and Muhammad Anees and Abdullah Faramarz and Abdur Rehman and Muhammad Abdullah Masood and Amit Kumar Thakur},
journal = {Frontiers in neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1848006},
url = {https://europepmc.org/article/PMC/PMC13668550},
note = {CC BY},
}
RIS
TY - JOUR
TI - Stress index (glucose-to-potassium ratio) as a predictor of outcome in traumatic brain injury: systematic review and meta-analysis
AU - Mesum Abbas
AU - Muhammad Moin-Ud-Din Arshad
AU - Ali Sher
AU - Rimsha Maqsood
AU - Muhammad Bilal Akram
AU - Areena Fatima
AU - Sadat Ali
AU - Waqar Ali Shah
AU - Muhammad Anees
AU - Abdullah Faramarz
AU - Abdur Rehman
AU - Muhammad Abdullah Masood
AU - Amit Kumar Thakur
PY - 2026
DA - 2026/10/01
JO - Frontiers in neurology
DO - 10.3389/fneur.2026.1848006
UR - https://europepmc.org/article/PMC/PMC13668550
AB - 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. Methods: 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. Results: 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. Conclusion: 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.
SN - 1664-2295
ER -