The association of plasma glucose-to-lactate ratio (GLR) and 28-day all-cause mortality in sepsis with Escherichia coli infection: A retrospective cohort study based on the MIMIC-IV database

Using a retrospective cohort from the MIMIC-IV database, we aimed to investigate the independent association between the admission plasma glucose-to-lactate ratio (GLR) and 28-day all-cause mortality in adult sepsis patients with Escherichia coli bacteremia. We further characterized the shape of this relationship and assessed its consistency across clinically relevant subgroups. Adult patients with sepsis and confirmed E coli bacteremia from the Medical Information Mart for Intensive Care IV database were included. The association between GLR (analyzed both continuously and in quartiles) and 28-day mortality was assessed using multivariable Cox proportional hazards regression, adjusting for potential confounders. Subgroup analyses were performed. Among 395 included patients, 47 (11.9%) died within 28 days. Patients in the lowest GLR quartile (Q1, <43.5) had higher Sequential Organ Failure Assessment scores, lactate levels, and the highest mortality (22.2%). After multivariable adjustment, a higher GLR was independently associated with lower mortality (adjusted hazard ratio per 1-unit increase = 0.98, 95% confidence interval: 0.97-1.00). A nonlinear relationship was observed, with mortality risk decreasing steeply until a GLR of approximately 75. A lower admission GLR is an independent predictor of higher 28-day mortality in adults with E coli sepsis, exhibiting a nonlinear relationship. GLR may serve as a simple early prognostic marker for risk stratification in this patient population.