The Glucose-to-leukocyte Ratio (GLR) is a Predictor for Malignant and All-cause Mortality in Malignancy Patients: Evidence from NHANES 1999-2018

Abstract

Background: The glucose-to-leukocyte ratio (GLR), a marker of glucose metabolism and systemic inflammation, is linked to poor prognoses in various diseases. However, the association between GLR and mortality in cancer patients remains unclear. This study aim to investigate the relationship between GLR index and all-cause and malignant mortality in cancer patients.

Methods: A total of 2,186 cancer patients (except for hematological neoplasms) were enrolled from the National Health and Nutrition Examination Survey (1999-2018). Mortality outcomes were assessed by linking to National Death Index (NDI) records until December 31, 2019. Kaplan-Meier analysis, LogRank tests, and weighted multivariate logistic regression were conducted to examine the association between GLR and mortality in these patients. Additionally, restricted cubic splines (RCS) were used to explore non-linear relationships, and a two-piecewise Cox proportional hazards model was constructed around the inflection points.

Results: Restricted cubic splines revealed a U-shaped relationship between the GLR index and both all-cause and malignant mortality in cancer patients. Kaplan-Meier survival analysis indicated that patients with low GLR had significantly better overall survival than those with high GLR (P < 0.05). Specifically, a baseline GLR index below threshold values (GLR < 2.95 for all-cause and < 2.97 for malignant mortality) was associated with reduced mortality (HR: 0.72, 95% CI: 0.52–0.99 for all-cause; HR: 0.40, 95% CI: 0.24–0.67 for malignant). Conversely, a baseline GLR index above the thresholds (GLR ≥ 2.95 for all-cause and ≥ 2.97 for malignant) correlated with increased risk (HR: 1.06, 95% CI: 1.03–1.09 for all-cause; HR: 1.08, 95% CI: 1.02–1.14 for malignant).

Conclusion: A U-shaped association was found between the baseline GLR index and both malignant and all-cause mortality in American cancer patients, with both excessively high and low levels potentially leading to negative health outcomes.