Glucose-to-Potassium Ratio as a Prognostic Biomarker in Critically Ill Children: A Narrative Review
Nafisa Najwa Achsan1, Arina Setyaningtyas2*, Paulus Budiono Notopuro3
Abstract
Critically ill children in the Pediatric Intensive Care Unit (PICU) have a high risk of death, so simple and fast tools to identify those at greatest risk are needed. Scores such as PRISM, PELOD-2, PIM-3, and pSOFA require many variables, and their accuracy can depend on when they are calculated. The glucose-to-potassium ratio (GPR) has attracted attention as an alternative marker because it uses two routine blood tests available in most hospitals. This narrative review summarizes the physiological rationale and current evidence for GPR as a predictor of mortality in critically ill children. Literature from 2019 to 2026 was identified through non-systematic web-based searches of PubMed/PubMed Central, medRxiv, and publisher platforms. During severe stress, catecholamines, cortisol, and glucagon raise blood glucose, while insulin and catecholamines move potassium into cells and lower its serum level; together, these changes increase GPR and may reflect the severity of metabolic stress. In adults, a higher GPR has been linked to higher mortality in traumatic brain injury, intracerebral hemorrhage, ischemic stroke, acute aortic dissection, and thoracoabdominal trauma, although results in sepsis are conflicting. Evidence in children is very limited, with only one small study in severe traumatic brain injury identified. Differences in cut-off values and units, insulin therapy, and stress hyperglycemia complicate interpretation. GPR is a promising low-cost marker that merits evaluation as a complement to existing scores in the PICU. Prospective multicenter studies in children are needed to define reliable cut-offs and to test whether GPR adds value beyond existing scores.
Keywords
glucose-to-potassium ratio; pediatric intensive care unit; critical illness; mortality prediction; biomarker
Cite This Article
Achsan, N. N., Setyaningtyas, A., Notopuro, P. B. (2026). Glucose-to-Potassium Ratio as a Prognostic Biomarker in Critically Ill Children: A Narrative Review. International Journal of Scientific Advances (IJSCIA), Volume 7| Issue 6: Nov – Dec 2026, Pages 1030-1040. URL: https://www.ijscia.com/wp-content/uploads/2026/11/Volume7-Issue6-Nov-Dec-No.1126-1030-1040.pdf
Volume 7 | Issue 6: Nov – Dec 2026
