The stress hyperglycemia ratio (SHR) reflects acute glycemic response relative to chronic glycemic status and has been associated with adverse outcomes in critical illness. A study published in the European Journal of Medical Research examined the association between SHR and mortality in patients with heart failure (HF) complicated by acute kidney injury (AKI) and evaluated its incremental value in mortality risk assessment.
Data were obtained from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. A total of 1,312 eligible patients were stratified by SHR quartiles. The primary endpoints were 30-day and 90-day all-cause mortality, with in-hospital mortality as the secondary endpoint. Kaplan–Meier survival analysis, Cox proportional hazards regression, and restricted cubic spline analyses were used to assess associations. Discriminative performance was evaluated using receiver operating characteristic (ROC) curve analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).
Among patients (60.29% male), those in the highest SHR quartile had higher in-hospital (25.30%), 30-day (28.66%), and 90-day (33.23%) mortality compared with lower quartiles (all P≤0.009). Each 1-standard deviation increase in SHR was independently associated with in-hospital (HR 1.26; 95% CI 1.12-1.41), 30-day (HR 1.23; 95% CI 1.11-1.36), and 90-day mortality (HR 1.17; 95% CI 1.06-1.28). Restricted cubic spline analysis demonstrated a linear association between SHR and mortality risk. SHR demonstrated superior mortality discrimination compared with admission glucose and glycated hemoglobin (HbA1c) and enhanced model reclassification and discrimination when added to established prediction models. Subgroup analysis showed potential interactions between SHR and diabetes and renal disease.
Higher SHR was independently associated with increased mortality in patients with HF and AKI.
Addition of SHR to established models enhanced mortality risk discrimination compared with conventional glycemic measures.
