Öz
Purpose: This study aimed to evaluate the glucose to potassium ratio (GPR) as a potential biomarker for diagnosing active epileptic seizures in patients presenting to the emergency department.
Materials and Methods: This study was conducted at a tertiary university hospital's emergency department from January 1, 2022, to December 31, 2022. This study included patients presenting to the emergency department with generalized motor epileptic seizure activity and witnessed seizure activity (observed by health personnel) (Group A), and adult patients with a diagnosis of epilepsy visiting the neurology outpatient clinic for routine check-ups (Group B).
Results: A total of 119 and 118 patients in groups A and B, respectively, were included. Significant differences were observed in white blood cell counts, glucose, potassium, and GPR levels between the groups. Receiver Operating Characteristic (ROC) curve analysis indicated that a GPR cut-off value of 24.8 had a sensitivity of 71.4% and specificity of 66.9% [Area Under the Curve (AUC)= 0.758]. Multivariate logistic regression revealed that GPR was an independent predictor of epileptic seizure activity [Odds ratio (OR)=0.873, 95% confidence intervarl (CI) 0.831–0.917).
Conclusion: GPR is a promising independent biomarker for predicting active epileptic seizure activity, and is significantly associated with increased seizure episodes. This study underscores the potential of GPR as a simple, effective diagnostic tool, especially in emergency settings where advanced diagnostic methods may be unavailable. Further prospective studies are recommended to validate these findings and to assess their clinical implications.
Etik Beyan
Study approval was obtained from the clinical ethics committee of Ordu University Faculty of Medicine (Decision Number: 2023/48).
Kaynakça
- Sazgar M, Young MG. Seizures and Epilepsy in Absolute epilepsy and EEG rotation review, (Eds Sazgar M, Young MG);9-46. Cham, Springer International Publishing. 2019.
- Huff JS, Morris DL, Kothari RU, Gibbs MA, Emergency medicine seizure study group (EMSSG)*. Emergency department management of patients with Sseizures: A multicenter study. Acad Emerg Med. 2001;8:622–8.
- Restrepo-Vera JL, Coscojuela P, Fonseca E, Quintana M, Sarria-Estrada S, Santamarina E et al. Epileptic seizures in the emergency room: clinical and electroencephalographic findings associated with brain perfusion patterns on computed tomography. J Neurol. 2022;269:3761-69.
- Verny M, Greffard S. Contribution of geriatric model to the management of an epileptic seizure or epilepsy. Geriatr Psychol Neuropsychiatr Vieil. 2019;17:21–4.
- Li H, Chen K, Yang L, Wang Q, Zhang J, He J. The role of plasma cortisol in dementia, epilepsy, and multiple sclerosis: A Mendelian randomization study. Front Endocrinol (Lausanne). 2023;14:1107780.
- Lee SC, Baranowski ES, Sakremath R, Saraff V, Mohamed Z. Hypoglycaemia in adrenal insufficiency. Front Endocrinol (Lausanne). 2023;14:1198519.
- Gözübatık Çeli RG, Özkara Ç. Seizures with autonomic symptoms and sudden unexpected death in epilepsy (SUDEP). Turkish J Neurol. 2019;25:109–16.
- Boyuk F, Çalışkan S, Yigen R. Glucose-to-potassium ratio: A novel index associated with the clinical status in acute coronary syndrome patients. Ann Clin Anal Med. 2022;13.
- Katyayan A, Diaz-Medina G. Epilepsy: Epileptic syndromes and treatment. Neurol Clin. 2021;39:779–95.
- Young E, abelson J, lightman S. Cortisol pulsatility and its role in stress regulation and health. Front Neuroendocrinol. 2004;25:69–76.
- Sarabdjitsingh RA, Jezequel J, Pasricha N Mikasova L, Kerkhofs A, Karst H et al. Ultradian corticosterone pulses balance glutamatergic transmission and synaptic plasticity. Proc Natl Acad Sci. 2014;111:14265–70.
- Rider F, Turchinets A, Druzhkova T, Kustov G, Guekht A, Gulyaeva N. Dissimilar changes in serum cortisol after epileptic and psychogenic non-epileptic seizures: a promising biomarker in the differential diagnosis of paroxysmal events? Int J Mol Sci. 2024;25:7387.
- Tesfaye N, Seaquist ER. Neuroendocrine responses to hypoglycemia. Ann N Y Acad Sci. 2010;1212:12–28.
- Kurtz P, Claassen J, Schmidt JM Helbok R, Hanafy K A, Presciutti M et al. Reduced brain/serum glucose ratios predict cerebral metabolic distress and mortality after severe brain injury. Neurocrit Care. 2013;19:311–9.
- Ogura T, Satoh A, Ooigawa H, Sugiyama T, Takeda R,Fushihara G et al. Characteristics and prognostic value of acute catecholamine surge in patients with aneurysmal subarachnoid hemorrhage. Neurol Res. 2012;34:484–90.
- Fredj Z, Sawan M. Advanced nanomaterials-based electrochemical biosensors for catecholamines detection: challenges and trends. Biosensors (Basel). 2023;13:211.
- Lloyd C, Mohar C, Priano J. Hypokalemic cardiac arrest: narrative review of case reports and current state of science. J Emerg Nurs. 2022;48:310–6.
- Sharawat IK, Singh J, Dawman L, Singh A. Evaluation of risk factors associated with first episode febrile seizure. J Clin Diagn Res. 2016;10:10-3.
- Phan J, Ramos M, Soares T, Parmar MS. Poststroke seizure and epilepsy: a review of incidence, risk factors, diagnosis, pathophysiology, and pharmacological therapies. Oxid Med Cell Longev. 2022;2022:1–15.
- Lucke-Wold BP, Nguyen L, Turner RC, Logsdon AF Chen YW, Smith KE et al. Traumatic brain injury and epilepsy: Underlying mechanisms leading to seizure. Seizure. 2015;33:13–23.
- Demirtaş E, Korkmaz İ, Tekin Y, Demirtaş E, Çaltekin İ. Assessment of serum glucose/potassium ratio as a predictor for delayed neuropsychiatric syndrome of carbon monoxide poisoning. Hum Exp Toxicol. 2021;40:207–13.
- Johnson KB, Wiesmann WP, Pearce FJ. The effect of hypothermia on potassium and glucose changes in isobaric hemorrhagic shock in the rat. Shock. 1996;6:223–9.
- Chen Y, Peng Y, Zhang X, Liao J,Lin J,Chen L et al. The blood glucose-potassium ratio at admission predicts in-hospital mortality in patients with acute type A aortic dissection. Sci Rep. 2023;13:15707.
- Katipoğlu B, Demirtaş E. Assessment of serum glucose potassium ratio as a predictor for morbidity and mortality of blunt abdominal trauma. Ulus Travma Acil Cerrahi Derg. 2022;28:134–9.
- Turan E, Şahin A. Role of glucose/potassium ratio and shock index in predicting mortality in patients with isolated thoracoabdominal blunt trauma. Turkish journal of trauma & emergency surgery. 2022;28:1442–8.
- Su WT, Wu SC, Chou SE, Huang CY, Hsu SY, Liu HT et al. Higher mortality rate in moderate-to-severe thoracoabdominal injury patients with admission hyperglycemia than nondiabetic normoglycemic patients. Int J Environ Res Public Health. 2019;16.
- Marini JI, Sein ME. The role of the glucose potassium ratio in the management of traumatic brain injury. Korean J neurotrauma. 2023;19:82–9.
- Zhou W, Liu Y, Wang Z, Mao Z, Li M. Serum glucose/potassium ratio as a clinical risk factor for predicting the severity and prognosis of acute traumatic spinal cord injury. BMC Musculoskelet Disord. 2023;24:870.
- Lu Y, Ma X, Zhou X, Wang Y. The association between serum glucose to potassium ratio on admission and short-term mortality in ischemic stroke patients. Sci Rep. 2022;12:8233.
- Matano F, Fujiki Y, Mizunari T, Kotetsu K, Tamaki T, Murai Y et al. Serum glucose and potassium ratio as risk factors for cerebral vasospasm after aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2019;28:1951–7
Öz
Amaç: Bu çalışma, acil servise başvuran hastalarda aktif epileptik nöbetleri teşhis etmek için potansiyel bir biyobelirteç olarak glikoz-potasyum oranını (GPR) değerlendirmeyi amaçlamıştır.
Materyal ve Yöntemler: Bu çalışma, 1 Ocak 2022-31 Aralık 2022 tarihleri arasında üçüncü basamak üniversite hastanesinin acil servisinde yürütülmüştür. Bu çalışma, acil servise jeneralize tonik-klonik epileptik nöbet aktivitesi ile başvuran ve nöbet aktivitesine tanık olan (sağlık personeli tarafından gözlemlenen) hastaları (A Grubu) ve nöroloji polikliniğine rutin kontroller için başvuran epilepsi tanılı erişkin hastaları (B Grubu) içermiştir.
Bulgular: Sırasıyla A ve B gruplarında toplam 119 ve 118 hasta dahil edilmiştir. Gruplar arasında nötrofil, glikoz, potasyum ve GPR seviyelerinde anlamlı farklılıklar gözlenmiştir. Receiver Operating Characteristic (ROC) eğrisi analizi, 24.8'lik bir GPR kesme değerinin %71.4 duyarlılık ve %66.9 özgüllüğe sahip olduğunu [Area Under the Curve (AUC)= 0.758] göstermiştir. Çok değişkenli lojistik regresyon, GPR'nin epileptik nöbet aktivitesinin bağımsız bir belirleyicisi olduğunu ortaya koymuştur [Olabilirlik oranı (OR)=0.873, %95 güven aralığı 0.831–0.917,].
Sonuç: GPR, aktif epileptik nöbet aktivitesini tahmin etmek için umut vadeden bağımsız bir biyobelirteçtir ve artmış nöbet atakları ile anlamlı bir şekilde ilişkilidir. Bu çalışma, özellikle gelişmiş tanı yöntemlerinin mevcut olmadığı acil durumlarda, GPR'nin basit ve etkili bir tanı aracı olarak potansiyelini vurgulamaktadır. Bu bulguları doğrulamak ve klinik etkilerini değerlendirmek için daha fazla prospektif çalışma önerilmektedir.
Kaynakça
- Sazgar M, Young MG. Seizures and Epilepsy in Absolute epilepsy and EEG rotation review, (Eds Sazgar M, Young MG);9-46. Cham, Springer International Publishing. 2019.
- Huff JS, Morris DL, Kothari RU, Gibbs MA, Emergency medicine seizure study group (EMSSG)*. Emergency department management of patients with Sseizures: A multicenter study. Acad Emerg Med. 2001;8:622–8.
- Restrepo-Vera JL, Coscojuela P, Fonseca E, Quintana M, Sarria-Estrada S, Santamarina E et al. Epileptic seizures in the emergency room: clinical and electroencephalographic findings associated with brain perfusion patterns on computed tomography. J Neurol. 2022;269:3761-69.
- Verny M, Greffard S. Contribution of geriatric model to the management of an epileptic seizure or epilepsy. Geriatr Psychol Neuropsychiatr Vieil. 2019;17:21–4.
- Li H, Chen K, Yang L, Wang Q, Zhang J, He J. The role of plasma cortisol in dementia, epilepsy, and multiple sclerosis: A Mendelian randomization study. Front Endocrinol (Lausanne). 2023;14:1107780.
- Lee SC, Baranowski ES, Sakremath R, Saraff V, Mohamed Z. Hypoglycaemia in adrenal insufficiency. Front Endocrinol (Lausanne). 2023;14:1198519.
- Gözübatık Çeli RG, Özkara Ç. Seizures with autonomic symptoms and sudden unexpected death in epilepsy (SUDEP). Turkish J Neurol. 2019;25:109–16.
- Boyuk F, Çalışkan S, Yigen R. Glucose-to-potassium ratio: A novel index associated with the clinical status in acute coronary syndrome patients. Ann Clin Anal Med. 2022;13.
- Katyayan A, Diaz-Medina G. Epilepsy: Epileptic syndromes and treatment. Neurol Clin. 2021;39:779–95.
- Young E, abelson J, lightman S. Cortisol pulsatility and its role in stress regulation and health. Front Neuroendocrinol. 2004;25:69–76.
- Sarabdjitsingh RA, Jezequel J, Pasricha N Mikasova L, Kerkhofs A, Karst H et al. Ultradian corticosterone pulses balance glutamatergic transmission and synaptic plasticity. Proc Natl Acad Sci. 2014;111:14265–70.
- Rider F, Turchinets A, Druzhkova T, Kustov G, Guekht A, Gulyaeva N. Dissimilar changes in serum cortisol after epileptic and psychogenic non-epileptic seizures: a promising biomarker in the differential diagnosis of paroxysmal events? Int J Mol Sci. 2024;25:7387.
- Tesfaye N, Seaquist ER. Neuroendocrine responses to hypoglycemia. Ann N Y Acad Sci. 2010;1212:12–28.
- Kurtz P, Claassen J, Schmidt JM Helbok R, Hanafy K A, Presciutti M et al. Reduced brain/serum glucose ratios predict cerebral metabolic distress and mortality after severe brain injury. Neurocrit Care. 2013;19:311–9.
- Ogura T, Satoh A, Ooigawa H, Sugiyama T, Takeda R,Fushihara G et al. Characteristics and prognostic value of acute catecholamine surge in patients with aneurysmal subarachnoid hemorrhage. Neurol Res. 2012;34:484–90.
- Fredj Z, Sawan M. Advanced nanomaterials-based electrochemical biosensors for catecholamines detection: challenges and trends. Biosensors (Basel). 2023;13:211.
- Lloyd C, Mohar C, Priano J. Hypokalemic cardiac arrest: narrative review of case reports and current state of science. J Emerg Nurs. 2022;48:310–6.
- Sharawat IK, Singh J, Dawman L, Singh A. Evaluation of risk factors associated with first episode febrile seizure. J Clin Diagn Res. 2016;10:10-3.
- Phan J, Ramos M, Soares T, Parmar MS. Poststroke seizure and epilepsy: a review of incidence, risk factors, diagnosis, pathophysiology, and pharmacological therapies. Oxid Med Cell Longev. 2022;2022:1–15.
- Lucke-Wold BP, Nguyen L, Turner RC, Logsdon AF Chen YW, Smith KE et al. Traumatic brain injury and epilepsy: Underlying mechanisms leading to seizure. Seizure. 2015;33:13–23.
- Demirtaş E, Korkmaz İ, Tekin Y, Demirtaş E, Çaltekin İ. Assessment of serum glucose/potassium ratio as a predictor for delayed neuropsychiatric syndrome of carbon monoxide poisoning. Hum Exp Toxicol. 2021;40:207–13.
- Johnson KB, Wiesmann WP, Pearce FJ. The effect of hypothermia on potassium and glucose changes in isobaric hemorrhagic shock in the rat. Shock. 1996;6:223–9.
- Chen Y, Peng Y, Zhang X, Liao J,Lin J,Chen L et al. The blood glucose-potassium ratio at admission predicts in-hospital mortality in patients with acute type A aortic dissection. Sci Rep. 2023;13:15707.
- Katipoğlu B, Demirtaş E. Assessment of serum glucose potassium ratio as a predictor for morbidity and mortality of blunt abdominal trauma. Ulus Travma Acil Cerrahi Derg. 2022;28:134–9.
- Turan E, Şahin A. Role of glucose/potassium ratio and shock index in predicting mortality in patients with isolated thoracoabdominal blunt trauma. Turkish journal of trauma & emergency surgery. 2022;28:1442–8.
- Su WT, Wu SC, Chou SE, Huang CY, Hsu SY, Liu HT et al. Higher mortality rate in moderate-to-severe thoracoabdominal injury patients with admission hyperglycemia than nondiabetic normoglycemic patients. Int J Environ Res Public Health. 2019;16.
- Marini JI, Sein ME. The role of the glucose potassium ratio in the management of traumatic brain injury. Korean J neurotrauma. 2023;19:82–9.
- Zhou W, Liu Y, Wang Z, Mao Z, Li M. Serum glucose/potassium ratio as a clinical risk factor for predicting the severity and prognosis of acute traumatic spinal cord injury. BMC Musculoskelet Disord. 2023;24:870.
- Lu Y, Ma X, Zhou X, Wang Y. The association between serum glucose to potassium ratio on admission and short-term mortality in ischemic stroke patients. Sci Rep. 2022;12:8233.
- Matano F, Fujiki Y, Mizunari T, Kotetsu K, Tamaki T, Murai Y et al. Serum glucose and potassium ratio as risk factors for cerebral vasospasm after aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2019;28:1951–7
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Acil Tıp, Nöroloji ve Nöromüsküler Hastalıklar |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Haziran 2025 |
| Gönderilme Tarihi | 28 Şubat 2025 |
| Kabul Tarihi | 13 Mayıs 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 50 Sayı: 2 |
