Novel platelet-to-lymphocyte and glucose-to-lymphocyte ratios as prognostic markers in acute coronary syndrome

Background Systemic inflammation and metabolic stress play key roles in acute coronary syndrome (ACS) outcomes. The platelet-to-lymphocyte ratio (PLR) and glucose-to-lymphocyte ratio (GLR) are emerging biomarkers reflecting these processes, but their prognostic value in ACS remains unclear. Purpose The purpose of this study was to evaluate the association of PLR and GLR with the occurrence of follow-up mortality in patients hospitalized for acute coronary syndrome (ACS). Methods This retrospective cohort study included consecutive ACS patients hospitalized at Hippokration Hospital of Thessaloniki between 2015 and 2023. PLR and GLR were calculated at admission, and their associations with all-cause mortality were evaluated using multivariate logistic regression, Cox proportional hazards models, and Kaplan-Meier survival analysis. Receiver operating characteristic (ROC) curves were used to determine optimal cutoff values. Results In total, 853 patients were included. The median age was 65 years, and 72.3% of patients were male. Higher PLR (adjusted OR: 1.006, 95% CI: 1.005–1.008, p < 0.001) and GLR (aOR: 1.338, 95% CI: 1.049–1.708, p = 0.019) were independently associated with increased mortality. ROC analysis showed an AUC of 0.67 for PLR (cutoff value: 191.92) (Figure 1) and 0.60 for GLR (cutoff value: 66.8) (Figure 2). Kaplan-Meier curves revealed significantly lower survival in patients with elevated PLR (p = 0.008) and GLR (p = 0.018). Cox regression confirmed both markers as independent predictors of mortality over time (PLR aHR: 1.002, p < 0.001; GLR aHR: 1.002, p = 0.018). Conclusion PLR and GLR are independent predictors of mortality in ACS, underscoring their potential role as accessible, cost-effective biomarkers for risk stratification. Further prospective studies are warranted to validate their clinical utility in guiding personalized management strategies.