Association between glucose-to-platelet ratio and all-cause mortality in critically ill patients with acute myocardial infarction: a retrospective cohort study

Q: What are the key findings of this study?

The highest glucose-to-platelet ratio tertile was associated with a significantly increased risk of 30-day all-cause mortality (HR 1.60) compared to the lowest tertile in critically ill AMI patients.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction in critically ill patients (n=4676). Intervention: Glucose-to-platelet ratio (highest tertile) vs. Lowest glucose-to-platelet ratio tertile. Primary outcome: 30-day all-cause mortality (HR 1.60, 95% CI 1.35-1.90, p=<0.001).

Q: What does this research mean for the field?

Higher glucose-to-platelet ratio (GPR) is independently associated with increased 30-day and 360-day all-cause mortality in critically ill patients with acute myocardial infarction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the prognostic value of the glucose-to-platelet ratio measured within 24 hours of ICU admission for short- and long-term all-cause mortality in critically ill patients with acute myocardial infarction.

Xingzhan Zhang; Dakai Liang; Xia Luo; Ling Zhao; Jie Peng

doi:10.1186/s12872-026-06222-9

July 4, 2026BMC Cardiovascular DisordersOpen Access

Association between glucose-to-platelet ratio and all-cause mortality in critically ill patients with acute myocardial infarction: a retrospective cohort study

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Key result

High glucose-to-platelet ratio is linked to ~60% higher 30-day mortality in critically ill AMI patients.

HR 1.60
95% CI 1.35-1.90
P<0.001
n=4,676

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Why the study?

The prognostic value of the glucose-to-platelet ratio in ICU patients with acute myocardial infarction remains unclear.

Does an elevated glucose-to-platelet ratio (GPR) predict increased short- and long-term all-cause mortality in critically ill patients with acute myocardial infarction?

Key Points

To evaluate the prognostic value of the glucose-to-platelet ratio measured within 24 hours of ICU admission for short- and long-term all-cause mortality in critically ill patients with acute myocardial infarction.
Retrospective cohort study analyzed 4,676 adult ICU patients with acute myocardial infarction from the MIMIC-IV version 3.1 database.
The glucose-to-platelet ratio was calculated as the mean glucose concentration during the first 24 hours in the ICU divided by the first platelet count recorded during the same period.
Primary outcomes of 30-day and 360-day all-cause mortality were evaluated using multivariable Cox proportional hazards models, restricted cubic splines, and exploratory machine-learning prediction models.
Overall 30-day and 360-day mortality rates were 19.6% and 29.1%, respectively; in the fully adjusted model, each 1-unit increase in glucose-to-platelet ratio was associated with higher 30-day mortality (HR, 1.10; 95% CI, 1.05–1.15; P < 0.001) and 360-day mortality (HR, 1.12; 95% CI, 1.07–1.16; P < 0.001).
Compared with the lowest tertile (30-day mortality 15.2%; 360-day mortality 25.5%), the highest tertile (30-day mortality 26.4%; 360-day mortality 36.5%) had higher 30-day mortality (HR, 1.60; 95% CI, 1.35–1.90; P < 0.001) and 360-day mortality (HR, 1.29; 95% CI, 1.12–1.47; P < 0.001).
Restricted cubic splines revealed a nonlinear association for 30-day mortality (P for nonlinearity = 0.015) and an approximately linear pattern for 360-day mortality (P for nonlinearity = 0.335), while an internally validated ridge regression model achieved an AUROC of 0.816 (95% CI, 0.787–0.844).

Study Design

Type

Cohort (n=4,676)

Multicenter

No

Structured PICO

Does an elevated glucose-to-platelet ratio (GPR) predict increased short- and long-term all-cause mortality in critically ill patients with acute myocardial infarction?

P

Population

4,676 adult ICU patients with acute myocardial infarction were followed for up to 360 days to assess the association between early glucose-to-platelet ratio and all-cause mortality.

E

Exposure

Glucose-to-platelet ratio (GPR), calculated as the mean glucose concentration during the first 24 hours after ICU admission divided by the first platelet count recorded within the same period.

C

Comparator

Lowest GPR tertile (T1) compared against higher tertiles (T2, T3).

O

Outcome

30-day all-cause mortality from ICU admissionhard clinical

Main Result

Hazard Ratio: 1.6 (95% CI 1.35–1.9)

Absolute Event Rate: 26.4% vs 15.2%

p-value: p=<0.001

Higher glucose-to-platelet ratio (GPR) is independently associated with increased short- and long-term all-cause mortality in critically ill patients with AMI, serving as a potential early prognostic marker.

Limitations

Retrospective observational design cannot establish causality.
Exploratory prediction models lacked external validation.
HbA1c availability was insufficient for calculating stress hyperglycemia ratio (SHR), limiting direct comparison.
GPR did not demonstrate significantly better discrimination than its individual components (glucose or platelet count alone).

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Answers are grounded in this paper and cite their sources.

Implication

May inform early risk stratification in critically ill AMI; leaves open prospective validation before any practice change.

Abstract

Acute myocardial infarction (AMI) in critically ill patients is associated with high mortality. The glucose-to-platelet ratio (GPR), derived from routine early glucose and platelet measurements, may provide additional prognostic information, but its value in ICU patients with AMI remains unclear. This retrospective cohort study included 4,676 adult ICU patients with AMI from the MIMIC-IV version 3.1 database. GPR was calculated as the mean glucose concentration during the first 24 h after ICU admission divided by the first platelet count recorded within the same period. Outcomes were 30-day and 360-day all-cause mortality from ICU admission. Associations were assessed using multivariable Cox proportional hazards models, restricted cubic splines, and exploratory internally validated prediction models. Among 4,676 patients, the 30-day and 360-day mortality rates were 19.6% and 29.1%, respectively. In the fully adjusted model, each 1-unit increase in GPR was associated with higher 30-day mortality (HR, 1.10; 95% CI, 1.05–1.15) and 360-day mortality (HR, 1.12; 95% CI, 1.07–1.16; both P < 0.001). Compared with the lowest tertile, the highest GPR tertile was associated with increased 30-day mortality (HR, 1.60; 95% CI, 1.35–1.90) and 360-day mortality (HR, 1.29; 95% CI, 1.12–1.47; both P < 0.001). Spline analyses suggested nonlinearity only for 30-day mortality. In exploratory internal validation, ridge regression incorporating GPR achieved an area under the receiver operating characteristic curve of 0.816. Higher GPR was independently associated with increased short- and long-term all-cause mortality in critically ill patients with AMI. GPR may complement conventional variables for early ICU risk stratification.

Discussion

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Cite This Study

Zhang et al. (2026) conducted a cohort in Acute myocardial infarction in critically ill patients (n=4,676). Glucose-to-platelet ratio (highest tertile) vs. Lowest glucose-to-platelet ratio tertile was evaluated on 30-day all-cause mortality (HR 1.60, 95% CI 1.35-1.90, p=<0.001). The highest glucose-to-platelet ratio tertile was associated with a significantly increased risk of 30-day all-cause mortality (HR 1.60) compared to the lowest tertile in critically ill AMI patients.

synapsesocial.com/papers/6a4b4617997070ff83b5b8d1 https://doi.org/10.1186/s12872-026-06222-9

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Association between glucose-to-platelet ratio and all-cause mortality in critically ill patients with acute myocardial infarction: a retrospective cohort study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association between glucose-to-platelet ratio and all-cause mortality in critically ill patients with acute myocardial infarction: a retrospective cohort study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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