Abstract Background and Objectives: Ischemic stroke (IS) is a major global public health problem with high rates of mortality and disability. The glucose-to-lymphocyte ratio (GLR), an inflammatory marker reflecting metabolic and immune status, has recently attracted attention for prognostication in several diseases. However, its relationship with short-term mortality in IS patients remains unclear. This study investigates the association between GLR and 28-day all-cause mortality in IS patients. Methods: A retrospective cohort study was conducted using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Cox proportional-hazards regression, restricted cubic spline (RCS) analysis, Kaplan–Meier (K–M) survival curves, and stratified interaction analyses were used to elucidate the relationship between GLR and clinical outcomes. Mediation analysis was performed to evaluate whether heart rate mediates the GLR–mortality association. Results: A total of 1,307 patients were included. K–M curves revealed significantly lower 28-day survival in the high-GLR group (≥4.918) ( P < 0.001). Fully adjusted Cox regression showed that GLR was positively associated with 28-day mortality (hazard ratio HR = 1.338, 95% confidence interval CI: 1.115–1.604, P = 0.002). RCS analysis found no significant non-linear relationship ( P non-linear = 0.308). Subgroup analysis showed more significant association in patients who did not receive invasive ventilation (HR = 2.281, P interaction < 0.001). Mediation analysis indicated that heart rate partially mediated the GLR-mortality pathway, with a mediation proportion of 9.82% ( P = 0.030). Conclusions: Elevated GLR is significantly associated with increased 28-day all-cause mortality in IS patients, suggesting that GLR serves as a readily available biomarker for short-term risk stratification and clinical management for IS.
Lian et al. (2026) studied this question.