Department of Critical Care Medicine, The Second People's Hospital of Lianyungang, Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, China.
Department of Geriatrics, The Second People's Hospital of Lianyungang, Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, China.
Aging Clin Exp Res. 2024 Aug 22;36(1):175. doi: 10.1007/s40520-024-02831-6.
Community-acquired pneumonia (CAP) is a significant health issue among the elderly, with severe cases (SCAP) having high mortality rates. This study assesses the predictive significance of the stress hyperglycemia ratio (SHR) in elderly SCAP patients and its impact on outcomes in both diabetic and non-diabetic patients.
This retrospective study included 406 SCAP patients aged 65 or older from the Second People's Hospital of Lianyungang (January 2020 to December 2023). Data collected included demographics, medical history, vital signs, and lab results. SHR was calculated from initial blood glucose and estimated average glucose (HbA1c). Statistical analyses, including Cox regression and Kaplan-Meier analysis, evaluated SHR's impact on mortality. Mediation models explored the effects of neutrophil-lymphocyte ratio (NLR) and SHR.
The 28-day mortality rate was 21.67%. Deceased patients had higher age, Charlson Comorbidity Index, procalcitonin, NLR, glucose, and SHR levels compared to survivors (P < 0.05). Both SHR and NLR significantly increased mortality risk, particularly in non-diabetic patients. Combining NLR and SHR improved ROC AUC to 0.898, with 89.80% sensitivity and 81.10% specificity. Kaplan-Meier analysis showed higher cumulative survival for SHR < 1.14, regardless of diabetes status (P < 0.05). NLR mediated 13.02% of the SHR-survival relationship, while SHR mediated 14.06% of the NLR-survival relationship.
Elevated SHR is a significant mortality risk factor in elderly SCAP patients, independent of diabetes status. Stringent glucose control and careful monitoring of SHR may improve outcomes in elderly patients with acute respiratory conditions.
社区获得性肺炎（CAP）是老年人的一个重大健康问题，重症病例（SCAP）死亡率较高。本研究评估了应激高血糖比值（SHR）在老年 SCAP 患者中的预测意义及其对糖尿病和非糖尿病患者结局的影响。
本回顾性研究纳入了连云港市第二人民医院 406 例年龄在 65 岁及以上的 SCAP 患者（2020 年 1 月至 2023 年 12 月）。收集的数据包括人口统计学、病史、生命体征和实验室结果。SHR 由初始血糖和估计平均血糖（HbA1c）计算得出。统计分析包括 Cox 回归和 Kaplan-Meier 分析，评估 SHR 对死亡率的影响。中介模型探讨了中性粒细胞-淋巴细胞比值（NLR）和 SHR 的影响。
28 天死亡率为 21.67%。死亡患者的年龄、Charlson 合并症指数、降钙素原、NLR、血糖和 SHR 水平均高于存活患者（P<0.05）。SHR 和 NLR 均显著增加了死亡风险，尤其是在非糖尿病患者中。NLR 和 SHR 联合使用可将 ROC AUC 提高至 0.898，灵敏度为 89.80%，特异性为 81.10%。Kaplan-Meier 分析显示，无论糖尿病状态如何，SHR<1.14 的患者累积生存率更高（P<0.05）。NLR 介导了 SHR 与生存关系的 13.02%，而 SHR 介导了 NLR 与生存关系的 14.06%。
在老年 SCAP 患者中，升高的 SHR 是死亡率的一个重要危险因素，独立于糖尿病状态。严格的血糖控制和对 SHR 的仔细监测可能会改善急性呼吸状况老年患者的结局。
