Xie Linfeng, Chen Jing, Li Yuanzhu, Huang Bi, Luo Suxin
Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
Diabetol Metab Syndr. 2024 Dec 24;16(1):312. doi: 10.1186/s13098-024-01562-y.
The stress hyperglycemia ratio (SHR) has been established as a predictor of unfavorable outcomes across various diseases. However, its relationship with prognosis in patients with cardiogenic shock (CS) remains unclear. This study aims to investigate the association between SHR and outcomes in CS patients.
A total of 904 CS patients with their first ICU admission were included in this study, utilizing data from the American Medical Information Mart for Intensive Care (MIMIC-IV) database. The primary endpoints were all-cause mortality at 30 days and 360 days. Patients were stratified into three groups based on the tertiles of the SHR.
The mean age of the cohort was 67.62 years, with 67.3% of participants being men. During the follow-up period, 221 patients (24.4%) died within 30 days, and 360 patients (39.8%) died within 360 days. The 30-day all-cause mortality rates were 16.9%, 22.3%, and 34.2% in the T1, T2, and T3 groups, respectively (p < 0.001), while the 360-day all-cause mortality rates were 34.9%, 39.0%, and 45.6%, respectively (p = 0.015). Compared with patients in T1, those in T3 exhibited a significantly higher risk of 30-day all-cause mortality (HR = 2.140, 95% CI: 1.522-3.008, p < 0.001) and 360-day all-cause mortality (HR = 1.495, 95% CI: 1.157-1.931, p = 0.002). Restricted cubic spline (RCS) analyses demonstrated an approximately linear relationship between SHR and 360-day all-cause mortality (p for overall = 0.011; p for nonlinearity = 0.099). However, a nonlinear association was observed between SHR and 30-day all-cause mortality (p for overall < 0.001; p for nonlinearity = 0.030), with the risk increasing significantly when SHR exceeded 1.176. Subgroup analyses revealed that the effect of SHR was consistent across most subgroups except in patients with and without acute myocardial infarction (AMI). In patients with AMI, SHR was associated with a significantly elevated risk of mortality, whereas no significant association was observed in patients without AMI. For 30-day all-cause mortality, the HR was 1.059 (95% CI: 1.040-1.078) in patients with AMI and 1.002 (95% CI: 0.966-1.040) in those without AMI (p for interaction = 0.007). For 360-day all-cause mortality, the HR was 1.043 (95% CI: 1.026-1.061) in patients with AMI and 0.984 (95% CI: 0.955-1.014) in those without AMI (p for interaction < 0.001).
Elevated SHR was significantly associated with increased 30-day and 360-day all-cause mortality in patients with CS, particularly in those with CS complicated by AMI. SHR may serve as a valuable marker for risk stratification and guiding subsequent interventions in CS patients. However, further prospective studies are needed to confirm these findings.
应激性高血糖比率（SHR）已被确立为各种疾病不良预后的预测指标。然而，其与心源性休克（CS）患者预后的关系仍不明确。本研究旨在探讨CS患者中SHR与预后的关联。
本研究纳入了904例首次入住重症监护病房（ICU）的CS患者，利用来自美国重症监护医学信息集市（MIMIC-IV）数据库的数据。主要终点为30天和360天的全因死亡率。根据SHR的三分位数将患者分为三组。
该队列的平均年龄为67.62岁，67.3%的参与者为男性。在随访期间，221例患者（24.4%）在30天内死亡，360例患者（39.8%）在360天内死亡。T1、T2和T3组的30天全因死亡率分别为16.9%、22.3%和34.2%（p<0.001），而360天全因死亡率分别为34.9%、39.0%和45.6%（p=0.015）。与T1组患者相比，T3组患者30天全因死亡风险显著更高（HR=2.140，95%CI：1.522-3.008，p<0.001），360天全因死亡风险也更高（HR=1.495，95%CI：1.157-1.931，p=0.002）。受限立方样条（RCS）分析表明SHR与360天全因死亡率之间存在近似线性关系（总体p=0.011；非线性p=0.099）。然而，观察到SHR与30天全因死亡率之间存在非线性关联（总体p<0.001；非线性p=0.030），当SHR超过1.176时风险显著增加。亚组分析显示，除了有和没有急性心肌梗死（AMI）的患者外，SHR的影响在大多数亚组中是一致的。在有AMI的患者中，SHR与显著升高的死亡风险相关，而在没有AMI的患者中未观察到显著关联。对于30天全因死亡率，有AMI的患者HR为1.059（95%CI：1.040-1.078），没有AMI的患者HR为1.002（95%CI：0.966-1.040）（交互作用p=0.007）。对于360天全因死亡率，有AMI的患者HR为1.043（95%CI：1.026-1.
