Yue Yong, Li Pengcheng, Sun Zhengyu, Wang Xiaoyi, Li Zongping, Zhang Ye
Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China.
Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan.
Front Endocrinol (Lausanne). 2025 May 2;16:1558352. doi: 10.3389/fendo.2025.1558352. eCollection 2025.
Hemorrhagic stroke (HS), including intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), is associated with high mortality and morbidity. Stress hyperglycemia ratio (SHR), reflecting acute glycemic responses relative to baseline glucose levels, has been linked to poor outcomes in critical illnesses. However, research on its prognostic significance in HS patients admitted to the intensive care unit (ICU) is limited. This study aims to assess the association between SHR and all-cause mortality (ACM) in critically ill HS patients.
Patients diagnosed with HS were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database using ICD-9/10 codes. SHR was calculated as [admission glucose (mg/dL)/(28.7 × HbA1c (%) - 46.7)]. Patients were stratified into tertiles. Primary outcomes were ICU, in-hospital, 30-day, 90-day, 180-day, and 1-year mortality. Cox regression and restricted cubic splines (RCS) evaluated the dose-response relationship between SHR and ACM. Kaplan-Meier (K-M) analysis assessed survival across tertiles, with subgroup analysis and interaction tests for effect modification.
The study included 1,749 patients, with a median age of 68 years (IQR: 57-79), and 53.2% were male. The observed mortality rates were 10.6% in the ICU, 15.2% in-hospital, 19.6% at 30 days, 24.2% at 90 days, 27.8% at 180 days, and 31.7% at 1 year. Multivariate Cox regression analysis indicated that elevated SHR was independently associated with increased ACM at 30 days (adjusted hazard ratio [aHR]: 1.41; 95% confidence interval [CI]: 1.10-1.81; P = 0.006), 90 days (aHR: 1.33; 95% CI: 1.08-1.65; P = 0.008), and 1 year (aHR: 1.27; 95% CI: 1.05-1.54; P = 0.014). RCS analysis demonstrated a linear association between SHR and ACM, with no evidence of non-linearity. Subgroup analysis revealed consistent associations across various patient characteristics.
SHR is significantly associated with ACM in critically ill patients with HS, supporting its potential role as a prognostic marker for risk stratification and guiding clinical management. Incorporating SHR into routine risk assessment may facilitate early identification of high-risk patients, enabling timely interventions and improved outcomes.
出血性卒中（HS），包括脑出血（ICH）和蛛网膜下腔出血（SAH），与高死亡率和高发病率相关。应激高血糖比值（SHR）反映相对于基线血糖水平的急性血糖反应，已被证明与危重症患者的不良预后有关。然而，关于其在入住重症监护病房（ICU）的HS患者中的预后意义的研究有限。本研究旨在评估SHR与危重症HS患者全因死亡率（ACM）之间的关联。
使用ICD - 9/10编码从重症监护医学信息数据库IV（MIMIC - IV）中提取诊断为HS的患者。SHR计算为[入院血糖（mg/dL）/（28.7×糖化血红蛋白A1c（%） - 46.7）]。患者被分为三个三分位数组。主要结局为ICU死亡率、住院死亡率、30天死亡率、90天死亡率、180天死亡率和1年死亡率。Cox回归和限制性立方样条（RCS）评估SHR与ACM之间的剂量反应关系。Kaplan - Meier（K - M）分析评估各三分位数组的生存率，并进行亚组分析和交互检验以评估效应修饰。
该研究纳入了1749例患者，中位年龄为68岁（四分位间距：57 - 79岁），53.2%为男性。观察到的ICU死亡率为10.6%，住院死亡率为15.2%，30天死亡率为19.6%，90天死亡率为24.2%，180天死亡率为27.8%，1年死亡率为31.7%。多变量Cox回归分析表明，SHR升高与30天（调整后风险比[aHR]：1.41；95%置信区间[CI]：1.10 - 1.81；P = 0.006）、90天（aHR：1.33；95% CI：1.08 - 1.65；P = 0.008）和1年（aHR：1.27；95% CI：1.05 - 1.54；P = 0.014）时的ACM增加独立相关。RCS分析显示SHR与ACM之间存在线性关联，无非线性证据。亚组分析揭示了在各种患者特征中一致的关联。
SHR与危重症HS患者的ACM显著相关，支持其作为风险分层和指导临床管理的预后标志物的潜在作用。将SHR纳入常规风险评估可能有助于早期识别高危患者，从而实现及时干预并改善预后。
