Relationship between GLR and 28-day all-cause mortality in patients with hypertensive heart disease complicated by heart failure: A retrospective analysis of the MIMIC-IV database

Hypertensive heart disease (HHD) complicated by heart failure is a significant cause of morbidity and mortality. The glucose-to-lymphocyte ratio (GLR) has been suggested as a potential marker of inflammation and stress. This study aimed to investigate the relationship between GLR and 28-day all-cause mortality in patients with HHD complicated by heart failure using the Medical Information Mart for Intensive Care, version IV database. We conducted a retrospective analysis of 6203 patients admitted to the intensive care unit (ICU) with HHD complicated by heart failure. Patients were excluded if they were not admitted to the ICU, had glucose deficiency, lymphocytopenia, or were identified as outliers. Patients were divided into quartiles based on GLR values. Cox regression models were used to evaluate the association between GLR and 28-day all-cause mortality. Subgroup analyses were performed to assess the impact of various clinical factors on this relationship. The study population had a mean age of 73.2 years, with 42.0% being male. The median GLR was 11.2 (interquartile range 6.4-20.0). In univariate Cox regression analysis, GLR was significantly associated with 28-day all-cause mortality (hazard ratio [HR] 1.0049, 95% confidence interval [CI] 1.0037-1.006, P < .001). Multivariate analysis confirmed this association, with the highest GLR quartile (Q4) showing a significantly higher risk of mortality compared to the lowest (Q1) (HR 2.57, 95% CI 2.18-3.03, P < .001). Threshold effect analysis identified a turning point at GLR 31.879, where the hazard ratio was 1.04 (95% CI 1.032-1.048, P < .001) for GLR below this value and 1.0023 (95% CI 0.9949-1.0097, P = .5481) for GLR above it. Kaplan-Meier survival analysis and forest plots further supported these findings. GLR is significantly associated with 28-day all-cause mortality in patients with HHD complicated by heart failure. Higher GLR values are associated with an increased risk of mortality. Our findings suggest that GLR could serve as a useful prognostic marker in this patient population.