{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:00:24Z","timestamp":1790830824524,"version":"4.1.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Traumatic brain injury (TBI) is a major cause of death and disability. The glucose-to-potassium ratio (GPR), or stress index (SI), reflects stress hyperglycemia and hypokalemia and may improve early prognostication beyond clinical and radiologic scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We performed a PRISMA-guided systematic review and meta-analysis of observational cohort studies in adults (\u226518\u202fyears) with CT-confirmed TBI reporting admission glucose and potassium and their association with mortality or functional\/\u201cpoor outcome.\u201d Random-effects models pooled odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) for continuous GPR values; heterogeneity was assessed with I\n                      <jats:sup>2<\/jats:sup>\n                      . Prespecified subgroup analyses were conducted by sample size (&amp;gt;500 vs.\u202f&amp;lt;\u202f500), with sensitivity analyses (leave-one-out; fixed vs. random) and funnel-plot inspection to explore robustness and small-study effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Three studies (4,550 patients) contributed to the primary comparison of high versus low GPR and mortality. High GPR was associated with increased odds of death (pooled OR 11.97, 95% CI 2.68\u201353.37;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001; I\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f88%). Across four studies, patients with poor outcomes had higher admission GPR than those with good outcomes (pooled MD 16.82, 95% CI 12.70\u201320.94;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.00001; I\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f61%). In five studies evaluating GPR as a prognostic predictor, the pooled adjusted OR for adverse outcome was 2.10 (95% CI 1.51\u20132.93;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.0001; I\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f37%). Effects were larger in small single-center cohorts and more moderate, but significant, in the large registry-based study; sample size explained much of the between-study heterogeneity. Funnel-plot asymmetry suggested possible small-study effects\/publication bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Elevated admission GPR\/SI is associated with increased mortality and poor outcome in adult TBI and may capture early systemic stress. As a bedside metric derived from routine laboratory tests, it is a promising adjunct for early risk stratification. However, heterogeneity, small-study effects, and observational evidence warrant cautious interpretation; large multicenter prospective studies are needed to validate standardized thresholds and incremental value over existing prognostic models.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1848006","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:46:09Z","timestamp":1790829969000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Stress index (glucose-to-potassium ratio) as a predictor of outcome in traumatic brain injury: systematic review and meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Mesum","family":"Abbas","sequence":"first","affiliation":[{"name":"Quaid-e-Azam Medical College","place":["Bahawalpur, Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Moin-Ud-Din Arshad","sequence":"additional","affiliation":[{"name":"Quaid-e-Azam Medical College","place":["Bahawalpur, Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Sher","sequence":"additional","affiliation":[{"name":"Quaid-e-Azam Medical College","place":["Bahawalpur, Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rimsha","family":"Maqsood","sequence":"additional","affiliation":[{"name":"Quaid-e-Azam Medical College","place":["Bahawalpur, Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Bilal","family":"Akram","sequence":"additional","affiliation":[{"name":"Quaid-e-Azam Medical College","place":["Bahawalpur, Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Areena","family":"Fatima","sequence":"additional","affiliation":[{"name":"Quaid-e-Azam Medical College","place":["Bahawalpur, Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadat","family":"Ali","sequence":"additional","affiliation":[{"name":"Quaid-e-Azam Medical College","place":["Bahawalpur, Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waqar Ali","family":"Shah","sequence":"additional","affiliation":[{"name":"Quaid-e-Azam Medical College","place":["Bahawalpur, Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Anees","sequence":"additional","affiliation":[{"name":"Quaid-e-Azam Medical College","place":["Bahawalpur, Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Faramarz","sequence":"additional","affiliation":[{"name":"Quaid-e-Azam Medical College","place":["Bahawalpur, Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdur","family":"Rehman","sequence":"additional","affiliation":[{"name":"Quaid-e-Azam Medical College","place":["Bahawalpur, Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Abdullah Masood","sequence":"additional","affiliation":[{"name":"Quaid-e-Azam Medical College","place":["Bahawalpur, Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit Kumar","family":"Thakur","sequence":"additional","affiliation":[{"name":"Sukrajaj Hospital of Tropical and Infectious Disease","place":["Kathmandu, Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/S1474-4422(18)30415-0","article-title":"Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990\u20132016: a systematic analysis for the global burden of disease study 2016","volume":"18","author":"James","year":"2019","journal-title":"Lancet 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Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1848006\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:46:19Z","timestamp":1790829979000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1848006\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":33,"alternative-id":["10.3389\/fneur.2026.1848006"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1848006","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]},"article-number":"1848006"}}