Association of the glucose-to-lymphocyte ratio with short-term mortality in critically ill patients with documented mitral valve disease: A retrospective cohort study
- 1Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
Abstract
Objective: The glucose-to-lymphocyte ratio (GLR) integrates metabolic stress and lymphocyte depletion, but its prognostic relevance in critically ill patients with mitral valve disease (MVD) is uncertain. We examined the association between early GLR and short-term all-cause mortality.
Methods: We used MIMIC-IV version 3.0 to identify adults with a documented MVD diagnosis and calculable GLR from the first valid glucose and absolute lymphocyte measurements within 24 hours of ICU admission. Primary analyses used a 24-hour landmark and modeled log2-transformed GLR continuously. Cox regression, restricted cubic splines, multiple imputation, timing and phenotype sensitivity analyses, paired DeLong tests, bootstrap-corrected C-index, calibration, and decision-curve analysis were performed.
Results: Among 1,538 patients with calculable GLR, seven died by the 24-hour landmark, leaving 1,531 patients; 148 (9.7%) died by day 28 and 203 (13.3%) by day 90. In the primary complete-case model (n=1,245), each doubling of GLR was associated with higher 28-day mortality (HR 1.43, 95% CI 1.22-1.66) and 90-day mortality (HR 1.30, 95% CI 1.14-1.49; both P<0.001). Spline analyses showed no evidence of nonlinearity, and multiple-imputation and major sensitivity analyses were directionally consistent. GLR discriminated mortality better than glucose alone but not significantly better than lymphocyte count. Adding GLR to age, sex, SOFA, and CCI increased optimism-corrected C-index by 0.030 at 28 days and 0.023 at 90 days, with good calibration and modest net benefit.
Conclusions: Higher early GLR was independently associated with 28-day and 90-day mortality in critically ill patients with documented MVD and provided modest adjunctive prognostic information.
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BibTeX
@article{yuan2026association,
title = {{Association of the glucose-to-lymphocyte ratio with short-term mortality in critically ill patients with documented mitral valve disease: A retrospective cohort study}},
author = {Zhenyu Yuan and Lei Zhao and Hong Geng and Qiang Ji and Kun Zuo and Yuanzhi Luo and Guanli Liang and Gengxu He},
journal = {Science Progress},
year = {2026},
month = sep,
doi = {10.1177/00368504261495210},
url = {https://doi.org/10.1177/00368504261495210},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Association of the glucose-to-lymphocyte ratio with short-term mortality in critically ill patients with documented mitral valve disease: A retrospective cohort study
AU - Zhenyu Yuan
AU - Lei Zhao
AU - Hong Geng
AU - Qiang Ji
AU - Kun Zuo
AU - Yuanzhi Luo
AU - Guanli Liang
AU - Gengxu He
PY - 2026
DA - 2026/09/29
JO - Science Progress
DO - 10.1177/00368504261495210
UR - https://doi.org/10.1177/00368504261495210
AB - Objective: The glucose-to-lymphocyte ratio (GLR) integrates metabolic stress and lymphocyte depletion, but its prognostic relevance in critically ill patients with mitral valve disease (MVD) is uncertain. We examined the association between early GLR and short-term all-cause mortality. Methods: We used MIMIC-IV version 3.0 to identify adults with a documented MVD diagnosis and calculable GLR from the first valid glucose and absolute lymphocyte measurements within 24 hours of ICU admission. Primary analyses used a 24-hour landmark and modeled log2-transformed GLR continuously. Cox regression, restricted cubic splines, multiple imputation, timing and phenotype sensitivity analyses, paired DeLong tests, bootstrap-corrected C-index, calibration, and decision-curve analysis were performed. Results: Among 1,538 patients with calculable GLR, seven died by the 24-hour landmark, leaving 1,531 patients; 148 (9.7%) died by day 28 and 203 (13.3%) by day 90. In the primary complete-case model (n=1,245), each doubling of GLR was associated with higher 28-day mortality (HR 1.43, 95% CI 1.22-1.66) and 90-day mortality (HR 1.30, 95% CI 1.14-1.49; both P<0.001). Spline analyses showed no evidence of nonlinearity, and multiple-imputation and major sensitivity analyses were directionally consistent. GLR discriminated mortality better than glucose alone but not significantly better than lymphocyte count. Adding GLR to age, sex, SOFA, and CCI increased optimism-corrected C-index by 0.030 at 28 days and 0.023 at 90 days, with good calibration and modest net benefit. Conclusions: Higher early GLR was independently associated with 28-day and 90-day mortality in critically ill patients with documented MVD and provided modest adjunctive prognostic information.
SN - 0036-8504
SN - 2047-7163
ER -