Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China.
J Diabetes. 2024 Jun;16(6):e13567. doi: 10.1111/1753-0407.13567.
Reportedly, the stress-hyperglycemia ratio (SHR) is closely associated with poor prognosis in patients with severe acute disease. However, the community-dwelling may also be in a state of stress due to environmental exposure. Our study aimed to explore the association between SHR and all-cause mortality in the community-dwelling population.
A total of 18 480 participants were included out of 82 091 from the NHANES 1999-2014 survey. The Kaplan-Meier survival analyses were used to assess the disparities in survival rates based on SHR, and the log-rank test was employed to investigate the distinctions between groups. The multivariate Cox regression analysis and restricted cubic spline (RCS) analysis were performed to assess the association of SHR with all-cause mortality. A subgroup analysis was also conducted.
A total of 3188 deaths occurred during a median follow-up period of 11.0 (7.7; 15.4) years. The highest risk for all-cause mortality was observed when SHR≤ 0.843 or SHR ≥0.986 (log-rank p < .001). After adjusting for the confounding factors, compared with subjects in the second SHR quartile (Q2), participants in the highest (Q4, adjusted hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.28-1.73) and lowest quartiles (Q1, adjusted HR 1.37, 95% CI 1.16-1.60) have a higher probability of all-cause death. The RCS observed a dose-response U-shaped association between SHR and all-cause mortality. The U-shaped association between SHR and all-cause mortality was similar across subgroup analysis.
The SHR was significantly associated with all-cause mortality in the community-dwelling population, and the relationship was U-shaped.
据报道，应激-高血糖比值（SHR）与严重急性疾病患者的预后不良密切相关。然而，社区居民也可能因环境暴露而处于应激状态。我们的研究旨在探讨社区居民中 SHR 与全因死亡率之间的关系。
共纳入了 1999-2014 年 NHANES 调查中的 82091 名参与者中的 18480 名。采用 Kaplan-Meier 生存分析评估基于 SHR 的生存率差异，采用对数秩检验比较组间差异。采用多变量 Cox 回归分析和限制三次样条（RCS）分析评估 SHR 与全因死亡率的关系。还进行了亚组分析。
中位随访 11.0（7.7；15.4）年后共发生 3188 例死亡。当 SHR≤0.843 或 SHR≥0.986 时，全因死亡率风险最高（对数秩检验 p<0.001）。在校正混杂因素后，与第二 SHR 四分位（Q2）相比，最高（Q4，调整后危险比 [HR] 1.49，95%置信区间 [CI] 1.28-1.73）和最低四分位（Q1，调整后 HR 1.37，95% CI 1.16-1.60）的参与者全因死亡的可能性更高。RCS 观察到 SHR 与全因死亡率之间呈 U 形剂量反应关系。SHR 与全因死亡率之间的 U 形关联在亚组分析中相似。
SHR 与社区居民的全因死亡率显著相关，且呈 U 形关系。
