Serum glucose/potassium ratio as a clinical risk factor for predicting the severity and prognosis of acute traumatic spinal cord injury

Abstract

Abstract Objective Acute traumatic spinal cord injury (TSCI) can lead to poor prognosis, and clinical biomarkers have not been established to predict poor prognosis. This study aimed to determine the significance of serum glucose/potassium ratio (GPR) in evaluating TSCI severity and predicting prognosis. Methods An analysis of 520 clinical records of acute TSCI patients from January 2012 to June 2022 was conducted by the authors. The relationship between serum GPR and The American Spinal Injury Association Impairment Scale (AIS) grade 6-month post-trauma prognosis in addition to admission AIS grade was analyzed. In order to evaluate the discriminatory ability, a receiver operating characteristic curve was used. All methods were performed in accordance with the relevant guidelines and regulations. Results Based on the initial assessment of AIS grade, 256 (49.2%) patients were categorized into the severe TSCI group (AIS A-B), and there was a significant correlation between the severe TSCI group and serum GPR (p < 0.001). Serum GPR was reduced in an AIS grade-dependent manner (R=-0.540, p < 0.001). 262 (50.4%) patients were classified as poor prognosis according to the AIS grade at discharge. Serum GPR was also reduced in AIS grade in a discharge-dependent manner (R = -0.599, p < 0.001). It was significantly higher in the poor prognosis group compared to the good prognosis group (p < 0.001 ). Poor prognosis was significantly associated with sex(p = 0.009), severity of TSCI (p < 0.001), location of TSCI (p < 0.001), Surgical decompression(P < 0.018), body temperature (p < 0.001), heart rate (p < 0.001), systolic arterial pressure (SAP) (p < 0.001), diastolic arterial pressure (DAP) (p < 0.001), serum GPR (p < 0.001), serum glucose (p < 0.001), serum potassium (p < 0.001) and white blood cell (WBC) count (p = 0.003). Multivariate logistic regression analysis showed a significant correlation between poor prognosis and serum GPR (p = 0.023). The ROC analysis showed that the area under the curve (AUC) of serum GPR as a poor predictor of prognosis in TSCI patients was 0.842 (95% CI 0.808–0.875). Conclusion There was a significant relationship between serum GPR and admission injury severity and 6-month prognosis of acute TSCI patients. The serum GPR can be used to assess the severity of acute TSCI and predict the prognosis .