Leuko-Glycemic Index as a Predictor of Mortality and Morbidity in Trauma Patients

Abstract

Background: The accurate prediction of outcomes in critically injured trauma patients remains challenging. Simple, affordable biomarkers that indicate inflammatory and metabolic response to injury could help improve early risk prediction. This study aimed to evaluate the prognostic value of the leuko-glycemic index (LGI)—a composite of admission white blood cell count and blood glucose level—for predicting mortality and morbidity in multiple trauma patients admitted to the intensive care unit (ICU).

Methods: This analytical cross-sectional study included 407 consecutive multiple trauma patients (ISS ≥ 16) admitted to the ICU of a major trauma center in Yazd, Iran, between 2019 and 2021. LGI was calculated as (WBC count × blood glucose level) / 1000. The primary outcome was in-hospital mortality. Secondary outcomes included length of ICU stay, need for emergency interventions, and occurrence of infection. The optimal LGI cut-off for predicting mortality was determined using receiver operating characteristic (ROC) curve analysis with Youden's index.

Results: The mean LGI was significantly higher in non-survivors than in survivors (4,173.91 vs. 1,447.25 mg/dL·mm³, P < 0.001). ROC analysis demonstrated excellent predictive ability for in-hospital mortality (AUC = 0.905, 95% CI: 0.85-0.96). The optimal cut-off was 1,706.55 mg/dL·mm³, yielding a sensitivity of 91.7% and specificity of 76.7%. Based on this threshold, 145 patients (35.6%) were categorized as high LGI. High LGI was significantly associated with increased rates of intubation (28.2% vs. 6.9%), chest tube insertion (19.4% vs. 2.6%), blood product transfusions, ICU stay >10 days (25.7% vs. 5.9%), and in-hospital mortality (10.7% vs. 0.3%) (all P < 0.001). The high LGI group also had significantly longer mean ICU stays (7.4 vs. 3.6 days, P < 0.001).

Conclusion: The leuko-glycemic index is a simple, cost-effective and reliable predictor for in-hospital mortality and morbidity in multiple trauma patients. With a high sensitivity and specificity, LGI can serve as a valuable tool for early risk stratification upon ICU admission, independent of age and sex. Further multicentric studies are needed to establish the these findings and their application in various trauma patient populations.