Table 1_Association of glucose–lymphocyte ratio and short-term mortality in patients with sepsis complicated by ARDS during the acute phase: a multicenter retrospective cohort study.docx

BackgroundSepsis may precipitate acute respiratory distress syndrome (ARDS), a life-threatening pulmonary complication characterized by high mortality. The glucose-to-lymphocyte ratio (GLR) is a novel composite biomarker has demonstrated prognostic significance across multiple diseases. However, its association with short-term mortality in patients with sepsis-induced ARDS has not yet been clearly established.
MethodsIn this multicenter retrospective cohort analysis, data from 2,485 individuals in the MIMIC-IV database were used to construct the primary derivation cohort, while an additional set of 298 patients from the Affiliated Hospital of Xuzhou Medical University served as an independent cohort for external validation. All-cause mortality at 28 days was defined as the primary outcome of the study. Least absolute shrinkage and selection operator (LASSO)–Boruta selected predictors. We evaluated the relationship between the GLR and mortality by employing multivariable Cox proportional hazards modeling, complemented by restricted cubic spline (RCS) and subgroup analyses. Receiver operating characteristic curves (ROC) and decision curve analysis (DCA) quantified incremental value of GLR over the Acute Physiology Score III (APS III) and the Simplified Acute Physiology Score II (SAPS II).
ResultsIn the derivation cohort, higher GLR values were independently linked to an increased risk of 28-day mortality (adjusted HR 1.13 per unit increase, 95% CI: 1.053–1.211, P < 0.001). The finding was replicated in the external validation cohort. Short-term mortality increased linearly with rising GLR levels, as shown by RCS analysis. Subgroup analyses identified significant interactions: the prognostic value of GLR was significantly attenuated or lost in patients with high illness severity scores (SAPS II > 40, APS III > 53) or severe liver disease, while it remained robust in patients with lower severity scores and without severe liver disease. Incorporating GLR into APS III and SAPS II models improved their AUC values (APS III: 0.694 vs. 0.708; SAPS II: 0.678 vs. 0.696).
ConclusionsAn elevated GLR at admission independently predicts 28-day mortality in patients with sepsis-induced ARDS. This marker is especially useful for early risk stratification among patients without advanced liver dysfunction or severe physiological abnormalities.

背景：脓毒症可诱发急性呼吸窘迫综合征（ARDS）——一种以高死亡率为特征的致命性肺部并发症。葡萄糖淋巴细胞比值（GLR）作为一种新型复合生物标志物，已在多种疾病中展现出预后价值。然而，其与脓毒症诱发ARDS患者短期死亡率的关联尚未明确。
方法：本研究为多中心回顾性队列分析，采用MIMIC-IV数据库中的2485例患者数据构建主要推导队列，另纳入徐州医科大学附属医院的298例患者作为独立外部验证队列。本研究的主要结局指标为28天全因死亡率。通过最小绝对收缩和选择算子（LASSO）-博鲁塔（Boruta）筛选预测变量。我们采用多变量Cox比例风险模型评估GLR与死亡率的关联，并辅以限制性立方样条（RCS）分析与亚组分析。通过受试者工作特征曲线（ROC）与决策曲线分析（DCA）量化GLR相较于急性生理学评分Ⅲ（APS Ⅲ）、简化急性生理学评分Ⅱ（SAPS Ⅱ）的增量价值。
结果：在推导队列中，较高的GLR值与28天死亡率升高呈独立相关（校正后风险比每升高1个单位为1.13，95%置信区间：1.053~1.211，P<0.001）。该结果在外部验证队列中得到重复验证。限制性立方样条分析显示，短期死亡率随GLR水平升高呈线性升高趋势。亚组分析发现显著交互作用：在疾病严重程度评分较高（SAPS Ⅱ>40、APS Ⅲ>53）或合并严重肝病的患者中，GLR的预后价值显著减弱甚至消失；而在疾病严重程度较低且无严重肝病的患者中，GLR的预后价值仍保持稳定。将GLR纳入APS Ⅲ与SAPS Ⅱ模型后，二者的曲线下面积（AUC）均得到提升（APS Ⅲ：0.694 vs 0.708；SAPS Ⅱ：0.678 vs 0.696）。
结论：入院时升高的GLR可独立预测脓毒症诱发ARDS患者的28天死亡率。该标志物尤其适用于无晚期肝功能异常或严重生理异常的患者的早期风险分层。