Association between glucose-to-lymphocyte ratio and risk of in-hospital mortality in patients with acute ischemic stroke: a retrospective cohort study based on the MIMIC-IV database

The glucose-to-lymphocyte ratio has been proposed as a potential marker reflecting metabolic stress and immune-inflammatory status. This retrospective cohort study investigated the association between glucose-to-lymphocyte ratio and in-hospital mortality in patients with acute ischemic stroke using the MIMIC-IV database from 2008 to 2019. The primary outcome was in-hospital mortality. The glucose-to-lymphocyte ratio was analyzed as both a continuous variable and a categorical variable according to quartiles. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals, with adjustment for potential confounders. Restricted cubic spline analysis was performed to assess potential nonlinearity. Subgroup and sensitivity analyses were conducted to evaluate the robustness of the findings. Among 7,659 screened patients, 2,565 met the inclusion criteria. The overall in-hospital mortality rate was 18.4% (473/2,565). Patients in the highest glucose-to-lymphocyte ratio quartile (Q4, ≥ 9.4) had a significantly higher risk of in-hospital mortality than those in the lowest quartile (Q1, < 3.4) in the fully adjusted model (hazard ratio = 1.54, 95% confidence interval: 1.12–2.14, P = 0.009). When analyzed as a continuous variable, each 10-unit increase in the glucose-to-lymphocyte ratio was independently associated with a 14% higher risk of in-hospital mortality (hazard ratio = 1.14, 95% confidence interval: 1.05–1.25, P = 0.003). Restricted cubic spline modeling indicated a linear relationship (P for nonlinearity = 0.584). Subgroup and sensitivity analyses confirmed the robustness of these associations. A higher glucose-to-lymphocyte ratio was also associated with increased 90-day mortality (hazard ratio = 1.13, 95% confidence interval: 1.04–1.22, P = 0.005). An elevated glucose-to-lymphocyte ratio was independently and linearly associated with increased in-hospital mortality in patients with acute ischemic stroke, suggesting that it may serve as a practical prognostic marker. Further prospective multicenter studies are warranted to validate these findings.