Relationship between stress hyperglycemia ratio and allcause mortality in critically ill patients: Results from the MIMIC-IV database

Abstract

BackgroundStress hyperglycemia ratio (SHR) was developed to reduce the impact of long-term chronic glycemic factors on stress hyperglycemia levels, which have been linked to clinical adverse events. However, the relationship between SHR and the short- and long-term prognoses of intensive care unit (ICU) patients remains unclear.MethodsWe retrospectively analyzed 3,887 ICU patients (cohort 1) whose initial fasting blood glucose and hemoglobin A1c data within 24 hours of admission were available and 3,636 ICU patients (cohort 2) who were followed-up for 1-year using the Medical Information Mart for Intensive Care IV v2.0 database. Patients were divided into two groups based on the optimal cutoff value of SHR, which was determined using the receiver operating characteristic (ROC) curve.ResultsThere were 176 ICU deaths in cohort 1 and 378 patients experienced all-cause mortality during 1 year of follow-up in cohort 2. The results of logistic regression revealed that SHR was associated with ICU death (odds ratio 2.92 [95% confidence interval 2.14–3.97] P < 0.001), and non-diabetic patients rather than diabetic patients showed an increased risk of ICU death. As per the Cox proportional hazards model, the high SHR group experienced a higher incidence of 1-year all-cause mortality (hazard ratio 1.55 [95% confidence interval 1.26–1.90] P < 0.001). Moreover, SHR had an incremental effect on various illness scores in predicting ICU all-cause mortality.ConclusionSHR is linked to ICU death and 1-year all-cause mortality in critically ill patients, and it has an incremental predictive value in different illness scores. Moreover, we found that non-diabetic patients, rather than diabetic patients, showed an increased risk of all-cause mortality.

Prognostic significance of the stress hyperglycemia ratio in critically ill patients

“…Notably, this association was confined to non-diabetic patients in subgroup analysis, even after accounting for confounding variables [ 23 ]. This consistent pattern aligns with the observations reported by Zhang et al [ 17 ]. The precise underlying mechanisms remain elusive.…”

“…The investigation of the association between SHR and mortality among critically ill patients remains notably scarce in the existing literature. Recently, Zhang et al published findings revealing that an elevated SHR stood as an independent risk determinant for ICU mortality among a cohort of 3887 patients (OR: 2.92, 95% CI: 2.14–3.97, P < 0.001) [ 17 ]. Notably, their investigation categorized SHR into two distinct groups, utilizing a cut-off value of 1.23, implying an implicit assumption of a linear relationship between SHR and mortality.…”

Nutritional Prescription in ICU Patients: Does it Matter?

“…Maximum glucose difference, glycemic gap, glycemic lability, and stress hyperglycemia ratio were the predictors of mortality, as shown in different studies. 21 – 24 The evidence for glucose control in the ICU has evolved from tight glucose control (81–108 mg/dL) to maintaining glucose levels below 180 mg/dL as an acceptable target. 25 , 26 In our study, although not significant trajectory analysis linear plot 1 had lower mortality (23%).…”

The relative and combined ability of stress hyperglycemia ratio and N-terminal pro-B-type natriuretic peptide to predict all-cause mortality in diabetic patients with multivessel coronary artery disease

“…The exact cause of death for patients who died outside our hospital could not be determined. Many studies have investigated the association between SHR and all-cause mortality [ 24 , 44 , 45 ]. Therefore, cardiovascular mortality, nonfatal MI, and nonfatal stroke were not included in this study.…”