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Table 1_Stress index (glucose-to-potassium ratio) as a predictor of outcome in traumatic brain injury: systematic review and meta-analysis.docx Mesum Abbas (25151886) Muhammad Moin-Ud-Din Arshad (25151889) Ali Sher (24950281) Rimsha Maqsood (25151892) Muhammad Bilal Akram (25151895) Areena Fatima (25151898) Sadat Ali (25151901) Waqar Ali Shah (25151904) Muhammad Anees (7358408) Abdullah Faramarz (25151907) Abdur Rehman (11154) Muhammad Abdullah Masood (25151952) Amit Kumar Thakur (11926187) Neurology and Neuromuscular Diseases traumatic brain injury glucose-to-potassium ratio stress index prognosis mortality biomarker systematic review meta-analysis Background<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.</p>Methods<p>We performed a PRISMA-guided systematic review and meta-analysis of observational cohort studies in adults (≥18 years) with CT-confirmed TBI reporting admission glucose and potassium and their association with mortality or functional/“poor outcome.” Random-effects models pooled odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) for continuous GPR values; heterogeneity was assessed with I². Prespecified subgroup analyses were conducted by sample size (>500 vs. < 500), with sensitivity analyses (leave-one-out; fixed vs. random) and funnel-plot inspection to explore robustness and small-study effects.</p>Results<p>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 2.68–53.37; p = 0.001; I² = 88%). Across four studies, patients with poor outcomes had higher admission GPR than those with good outcomes (pooled MD 16.82, 95% CI 12.70–20.94; p < 0.00001; I² = 61%). In five studies evaluating GPR as a prognostic predictor, the pooled adjusted OR for adverse outcome was 2.10 (95% CI 1.51–2.93; p < 0.0001; I² = 37%). 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.</p>Conclusion<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.</p> 2026-10-01T04:32:08Z Dataset Dataset 10.3389/fneur.2026.1848006.s001 https://figshare.com/articles/dataset/Table_1_Stress_index_glucose-to-potassium_ratio_as_a_predictor_of_outcome_in_traumatic_brain_injury_systematic_review_and_meta-analysis_docx/34038246 CC BY 4.0