Association of the blood glucose-to-platelet ratio with all-cause mortality in diabetic patients: An analysis of the MIMIC-IV database

Diabetes mellitus is a chronic disease that significantly affects global mortality rates, particularly among critically ill individuals. While previous studies have highlighted the role of glucose regulation and platelet activity in mortality risk, the combined impact of blood glucose and platelet levels remains underexplored. This study aims to investigate the relationship between the blood glucose-to-platelet ratio (BPR) and all-cause mortality in critically ill diabetic patients. A retrospective analysis was conducted using the MIMIC-IV database, which included 21,145 critically ill diabetic patients admitted to the intensive care unit. Patients were categorized into quartiles based on their BPR. Mortality rates at 28 and 360 days post-admission were assessed. Cox proportional hazards models were used to evaluate the association between BPR and hospital mortality, adjusting for potential confounders such as age, sex, comorbidities, and illness severity scores. Restricted cubic spline analysis was applied to assess the nonlinear relationship between BPR and hospital mortality. The median age of patients was 69 years (interquartile range, 60–78), with 58.41% male. The crude 28-day and 360-day hospital mortality rates were 10.83% and 15.57%, respectively. Higher BPR quartiles were associated with increased mortality rates at both 28 days and 360 days ( P  < .001). The hazard ratio for 28-day hospital mortality between the highest (Q4) and lowest (Q1) quartiles was 1.69 in the unadjusted model and 1.36 after adjusting for confounders. Analysis using restricted cubic splines suggested a nonlinear relationship between BPR and hospital mortality, with an increase in risk observed as BPR levels increased. Subgroup analyses revealed consistent associations across different patient demographics and comorbid conditions, including age, sex, and sepsis. BPR appears to be a potential marker for predicting all-cause mortality in critically ill diabetic patients, with a moderate association between BPR and mortality risk. While the blood glucose-to-platelet ratio could serve as a useful tool for identifying high-risk patients, its clinical applicability in intensive care unit settings requires further investigation. Future studies should explore its role in dynamic monitoring and therapeutic interventions, as well as address the limitations of our current findings, such as the observational nature of the data and potential confounding factors.