An extensive U.S.-based cohort study published in the Acta Diabetologica reported that stress hyperglycemia ratio (SHR) independently predict long-term mortality in patients with metabolic syndrome (MetS).

Drawing on data from 9,438 adults with MetS from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, researchers stratified participants into three SHR tertiles: T1 (≤0.890), T2 (0.890–0.992), and T3 (≥0.992). SHR, a novel marker of acute hyperglycemia, has recently gained attention for its potential to flag adverse outcomes, but its role in MetS had not previously been explored.

Over an average follow-up of nearly nine years, 1,929 deaths were documented, including 541 from cardiovascular disease (CVD). Mortality rates—both all-cause and CVD-specific—were significantly higher in the highest SHR tertile (T3), with all-cause mortality at 23.4% compared to 18.3% in the lowest tertile (T1), and CVD mortality at 6.8% compared to 5.1%.

High SHR remained independently associated with a 25.6% higher risk of all-cause death and a modest but significant 2.3% increased risk of CVD mortality even after confounder adjustments. The relationship between SHR and mortality followed a U-shaped curve, indicating that both extremely low and high SHR values were associated with increased risk. Study reported a clear trend of worsening outcomes with increasing SHR values.