Association of serum glucose/potassium ratio with the prognosis of aneurysmal subarachnoid hemorrhage: a systematic review with meta-analysis
Claudia Cruzalegui Bazán1, Milenka Del Rosario Cierto Torre2, Renzo Vallejos2, Anaiz Ticona Flores2, José Luis Acha Sánchez3, Miguel Cabanillas Lazo2
1Universidad Nacional Mayor de San Marcos, Lima, Perú - Sociedad Científica de San Fernando, Lima, Perú, 2Universidad Nacional Mayor de San Marcos, Lima, Perú, 3Departamento de Neurocirugía del Hospital Nacional Dos de Mayo, Lima, Perú
Objective:
To conduct a systematic review with meta-analysis to evaluate the current evidence on the prognostic value of GPR in patients with aSAH.
Background:
Currently, the glucose/potassium ratio (GPR) is an important biomarker indicating the abundant release of catecholamines during aneurysmal subarachnoid hemorrhage (aSAH), which triggers different alterations in patients.
Design/Methods:
A systematic search was conducted in PubMed, Embase, Scopus, Web of Science, Google Scholar, Lilacs, and Cochrane Library until April 2022. The quality of the included studies was assessed using the New Castle-Ottawa tool. A meta-analysis with randomized effects model was applied using the Paule-Mendel estimator to estimate the pooled effect of the outcome and a narrative synthesis when this was not possible. GRADE criteria for continuous outcomes and narrative review were used to assess the certainty of the evidence.
Results:
Four of 368 studies were selected. With high certainty, we reported that a significant increase in GPR values was found in patients with a poor outcome according to Glasgow Scale Score (MD: 14.81; 95 CI: 12.47;17.15; I2=0%). With moderate certainty, we found a specificity of 0.50 for mortality at 3 months and with high certainty, a sensitivity of 0.90 for the mortality at 3 months. With a moderate certainty, one study showed a mean difference of 5.3 between poor and good prognosis (Rankin Scale > 2 at 3 months) and with the same certainty, we found a specificity of 0.63 for poor prognosis at 1 year (Rankin Scale > 2).
Conclusions:
With moderate certainty of the evidence, we found that GPR is useful as a prognostic biomarker in patients with aSAH. However, more research is required to control possible confounding variables through sensitivity and specificity analysis.