应激性高血糖比值作为非糖尿病脓毒症患者死亡率的预测指标：一项回顾性队列分析

Stress hyperglycemia ratio as a mortality predictor in non-diabetic septic patients: a retrospective cohort analysis.

作者信息

Feng Siyu, Zou Rui, Wang Yue, Huang Yuqin, Zhou Quan, Huang Qiang, Xu Huaqiang

机构信息

Department of Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, 441300, China.

出版信息

BMC Infect Dis. 2025 May 25;25(1):752. doi: 10.1186/s12879-025-11151-7.

DOI:10.1186/s12879-025-11151-7

PMID:40414847

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12105287/

Abstract

BACKGROUND

The stress hyperglycemia ratio (SHR) is associated with adverse events in critically ill patients. However, the relationship between SHR and mortality in non-diabetic septic patients remains unclear. This study aimed to investigate the correlation between SHR and mortality in non-diabetic septic patients.

METHODS

This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care (MIMIC-IV) database at Beth Israel Deaconess Medical Center in Boston. The study population was stratified into four groups based on quartiles of the SHR. The primary outcome was in-hospital mortality, while the secondary outcome was ICU mortality. Kaplan-Meier curves, the Log-rank test, and Cox regression analysis were employed to assess the association between SHR and all-cause mortality. Restricted cubic splines (RCS) regression analysis was conducted to explore the nonlinear relationship between SHR and outcomes. Additionally, subgroup analyses were performed to investigate differences among various patient subgroups.

RESULTS

This study included a cohort of 1,200 patients, with a median age of 68.44 years, and 43.42% were female. The in-hospital mortality and Intensive Care Unit (ICU) mortality rates were 19.67% and 15.42%, respectively. Cox regression analysis revealed that an elevated SHR was independently associated with both in-hospital mortality (Hazard Ratio [HR], 1.50; 95% Confidence Interval [CI], 1.05-2.13; P = 0.02) and ICU mortality (HR, 1.53; 95% CI, 1.04-2.24; P = 0.03). Furthermore, the relationship between SHR and mortality exhibited a U-shaped pattern, indicating that an increase in SHR correlates with an elevated risk of adverse events. The results of subgroup analyses were generally consistent with these findings.

CONCLUSIONS

In non-diabetic critically ill septic patients, SHR is significantly associated with an increased risk of adverse events. Consequently, SHR emerges as a potential predictor of poor outcomes in non-diabetic septic patients admitted to the ICU.

摘要

背景

应激性高血糖比值（SHR）与危重症患者的不良事件相关。然而，SHR与非糖尿病脓毒症患者死亡率之间的关系仍不明确。本研究旨在探讨非糖尿病脓毒症患者中SHR与死亡率之间的相关性。

方法

这项回顾性队列研究利用了波士顿贝斯以色列女执事医疗中心重症监护医学信息集市（MIMIC-IV）数据库的数据。根据SHR的四分位数将研究人群分为四组。主要结局是住院死亡率，次要结局是重症监护病房（ICU）死亡率。采用Kaplan-Meier曲线、对数秩检验和Cox回归分析来评估SHR与全因死亡率之间的关联。进行限制立方样条（RCS）回归分析以探讨SHR与结局之间的非线性关系。此外，进行亚组分析以研究不同患者亚组之间的差异。

结果

本研究纳入了1200例患者，中位年龄为68.44岁，43.42%为女性。住院死亡率和重症监护病房（ICU）死亡率分别为19.67%和15.42%。Cox回归分析显示，SHR升高与住院死亡率（风险比[HR]，1.50；95%置信区间[CI]，1.05 - 2.13；P = 0.02）和ICU死亡率（HR，1.53；95% CI，1.04 - 2.24；P = 0.03）均独立相关。此外，SHR与死亡率之间的关系呈U形模式，表明SHR升高与不良事件风险增加相关。亚组分析结果与这些发现总体一致。