Relationship between the Glucose to Lymphocyte Ratio and 30-day mortality in acute myocardial infarction patients: An analysis from the MIMIC-IV Database

Abstract Aim：To investigate the association between the glucose to lymphocyte ratio (GLR) and 30-day mortality in acute myocardial infarction (AMI) patients. Methods：A retrospective cohort analysis. Two thousand nine hundred and eleven AMI patients were enrolled using the Medical Information Mart for Intensive Care (MIMIC)-IV database. The patients were divided into four groups according to their GLR quantiles. The primary outcome was 30-day mortality. Multivariate Cox proportional risk regression models were used to examine the association between GLR and 30-day mortality. The non-linear relationship between GLR and 30-day mortality was confirmed using a Cox proportional risk regression model fitted by cubic spline function and smooth curve fitting. Results：Of the 2,911 participants, 426 (14.63%) died. The generalized additive model (GAM) showed that the relationship between admission GLR levels and 30-day mortality among AMI patients was non-linear (hazard ratio [HR] 1.01, 95% confidence interval [CI] 1.00–1.02, p = 0.0134). In addition,adjusted multivariable Cox regression analysis confirmed that the admission GLR levels of 3.60-6.06 was independently associated with decreased mortality compared to GLR levels of 0.60–3.59 (HR 1.49, 95% CI 1.02–2.18, p = 0.0409), GLR levels of 6.07–11.03 (HR 1.56, 95% CI 1.07–2.26, p = 0.0203), and GLR levels of 11.04-97.55 (HR 1.69, 95% CI 1.17–2.42, p = 0.0047). A two-piecewise regression model was used to obtain a threshold inflection point value of 4.66. The HR and the 95% CI on the left inflection point were 1.33 and 1.07–1.65, respectively, (p = 0.0116); on the right inflection point, they were 1.01 and 1.01–1.02, respectively, (p = 0.2630). Conclusions：The relationship between the GLR and 30-day mortality was nonlinear in AMI patients. The GLR was positively related with 30-day mortality when the GLR was less than 4.66.