Table 1_Stress index (glucose-to-potassium ratio) as a predictor of outcome in traumatic brain injury: systematic review and meta-analysis.docx

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>