Pan Haowei, Xiong Yiqun, Huang Yanming, Zhao Jie, Wan Haifang
Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
Department of Anesthesiology, Hangzhou Red Cross Hospital, 208 East Huancheng Road, Hangzhou, 310003, China.
Acta Diabetol. 2024 Jul;61(7):859-868. doi: 10.1007/s00592-024-02259-4. Epub 2024 Mar 19.
Hyperglycemia on admission is associated with poor prognosis in ischemic stroke (IS) patients. We aimed to investigate the relationship between stress hyperglycemia ratio (SHR) and short-term or long-term mortality in IS patients in the ICU and to explore whether this relationship is influenced by diabetes status.
We collected patients with severe IS requiring ICU admission in the Medical Information Mart for Intensive Care (MIMIC-IV) database and calculated SHR. Outcomes included 30-day, 90-day, and 1-year mortality. The association between SHR and mortality in patients with critical IS was elucidated using Multivariate Cox regression and subgroup analysis for diabetes.
A total of 1376 patients were recruited. After adjusting for potential confounders, patients in the third and fourth quartiles had a significantly increased risk of death at 30 days, 90 days, and 1 year compared to the first quartile of SHR (Q3 vs. Q1: HR 1.56-1.80, all p < 0.02; Q4 vs. Q1: HR 1.75-2.15, all p < 0.001; all p for trend < 0.001). In addition, the highest quartile of SHR was significantly associated with short-term or long-term mortality compared with the first quartile, regardless of diabetes status.
Our results suggest that stress hyperglycemia, defined by the glucose/HbA1c ratio, is associated with increased short-term and long-term mortality in patients with ischemic stroke, independent of the patient's diabetes status.
入院时高血糖与缺血性卒中（IS）患者的不良预后相关。我们旨在研究应激性高血糖比值（SHR）与重症监护病房（ICU）中IS患者短期或长期死亡率之间的关系，并探讨这种关系是否受糖尿病状态的影响。
我们在重症监护医学信息数据库（MIMIC-IV）中收集了需要入住ICU的重症IS患者，并计算了SHR。结局包括30天、90天和1年死亡率。使用多变量Cox回归和糖尿病亚组分析阐明了重症IS患者中SHR与死亡率之间的关联。
共招募了1376例患者。在调整潜在混杂因素后，与SHR第一四分位数相比，第三和第四四分位数的患者在30天、90天和1年时死亡风险显著增加（Q3 vs. Q1：HR 1.56 - 1.80，所有p < 0.02；Q4 vs. Q1：HR 1.75 - 2.15，所有p < 0.001；所有趋势p < 0.001）。此外，无论糖尿病状态如何，SHR最高四分位数与第一四分位数相比，均与短期或长期死亡率显著相关。
我们的结果表明，由血糖/HbA1c比值定义的应激性高血糖与缺血性卒中患者短期和长期死亡率增加相关，与患者的糖尿病状态无关。
