Jin Meng, Bao Ziyi, Hong Xiaqing, He Songbin, Gao Feng
Department of Neurology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Department of Neurology, School of Medicine, Zhoushan Hospital, Wenzhou Medical University, Zhoushan 316000, Zhejiang Province, China.
J Diabetes Complications. 2025 Apr;39(4):108979. doi: 10.1016/j.jdiacomp.2025.108979. Epub 2025 Mar 5.
The stress hyperglycemia ratio (SHR), originally proposed in 2015 by Robert et al., is more significantly relevant and predictive of critical illness than absolute hyperglycemia. Several studies have validated the association between stress hyperglycemia ratio and cerebrovascular disease. However, the value of stress hyperglycemia ratio for severe stroke patients admitted to the ICU remains uncertain. The aim of this study was to investigate the relationship between stress hyperglycemia ratio and clinical short- and long-term prognosis of critically ill patients with acute ischemic stroke (AIS).
Clinical data from 893 critically ill patients with ischemic stroke (IS) were extracted from the Medical Information Marketplace for Intensive Care (MIMIC-IV) database and 793 critically ill IS patients with 1 year of follow-up. The SHR is expressed by the formula: SHR = [(admission glucose (mg/dl)) / (28.7 × HbA1c (%) - 46.7)]. The study population was categorized into quartiles based on SHR level. Outcomes included ICU mortality, hospital mortality, and 1-year mortality. Cox proportional risk regression analysis and restricted cubic spline curves were used to elucidate the association between SHR and clinical prognosis in critically ill patients with AIS.
There were 69 ICU deaths and 100 in-hospital deaths in cohort 1, and 229 patients experienced all-cause mortality during the 1-year follow-up in cohort 2. Multivariate Cox proportional risk analysis showed that elevated SHR was significantly associated with an increased risk of hospital and 1-year all-cause mortality. After adjusting for confounders, patients with elevated SHR were significantly associated with hospital mortality (adjusted risk ratio, 1.870; 95 % confidence interval, 1.180-2.962; P = 0.008) and 1-year mortality (adjusted risk ratio, 2.325; 95 % confidence, 1.729-3.127; P < 0.001). Restricted cubic spline bars showed that a progressively increasing risk of all-cause mortality was associated with an elevated SHR.
Stress hyperglycemia ratios were significantly associated with in-hospital and 1-year all-cause mortality in critically ill IS patients. Moreover, we found that non-diabetic and prediabetic patients showed an increased risk of all-cause mortality. It is suggested that SHR may be useful in identifying ischemic stroke patients at high risk of all-cause mortality and providing personalized interventions as early as possible.
应激性高血糖比率（SHR）由罗伯特等人于2015年首次提出，与绝对高血糖相比，它与危重病的相关性更强且更具预测性。多项研究证实了应激性高血糖比率与脑血管疾病之间的关联。然而，应激性高血糖比率对入住重症监护病房（ICU）的重症卒中患者的价值仍不确定。本研究旨在探讨应激性高血糖比率与急性缺血性卒中（AIS）危重症患者临床短期和长期预后之间的关系。
从重症监护医学信息市场（MIMIC-IV）数据库中提取893例缺血性卒中（IS）危重症患者的临床数据，并对793例IS危重症患者进行为期1年的随访。SHR由公式表示：SHR = [(入院血糖（mg/dl）)/ (28.7 ×糖化血红蛋白A1c（%） - 46.7)]。根据SHR水平将研究人群分为四分位数。结局指标包括ICU死亡率、医院死亡率和1年死亡率。采用Cox比例风险回归分析和受限立方样条曲线来阐明SHR与AIS危重症患者临床预后之间的关联。
队列1中有69例ICU死亡和100例医院死亡，队列2中有229例患者在1年随访期间发生全因死亡。多变量Cox比例风险分析表明，SHR升高与医院和1年全因死亡风险增加显著相关。在调整混杂因素后，SHR升高的患者与医院死亡率（调整风险比，1.870；95%置信区间，1.180 - 2.962；P = 0.008）和1年死亡率（调整风险比，2.325；95%置信区间，1.729 - 3.127；P < 0.001）显著相关。受限立方样条图显示，全因死亡风险的逐渐增加与SHR升高相关。
应激性高血糖比率与IS危重症患者的医院和1年全因死亡率显著相关。此外，我们发现非糖尿病和糖尿病前期患者的全因死亡风险增加。建议SHR可能有助于识别全因死亡风险高的缺血性卒中患者，并尽早提供个性化干预措施。
