Dong Yitian, Ye Jiayuan, Li Hui, Kong Weiliang, Qian Guoqing, Xie Yilian
Health Science Center, Ningbo University, Ningbo, Zhejiang, China.
Department of Infectious Diseases, Shangyu People's Hospital Of Shaoxing, Shaoxing, Zhejiang, China.
BMC Gastroenterol. 2025 Jul 1;25(1):477. doi: 10.1186/s12876-025-04082-9.
Stress hyperglycemia ratio (SHR), an index reflecting relative hyperglycemia under stress conditions, has been linked to adverse outcomes in various clinical settings. However, its prognostic significance in individuals with nonalcoholic fatty liver disease (NAFLD) remains poorly understood. This study aimed to examine the association between SHR and mortality risk in adults with NAFLD.
We analyzed 12,604 adults with NAFLD from the NHANES 1999-2018 database. Multivariable Cox proportional hazards models, restricted cubic spline (RCS) analysis, and Fine-Gray competing risk models were employed to evaluate associations between SHR and all-cause and cardiovascular mortality, RESULTS: During an overall mean follow-up time of 99.26 months, a U-shaped relationship was observed between SHR and all-cause mortality in adults aged 40-59 years and ≥ 60 years. Risk increased at both low and high SHR levels, with identified thresholds at 0.89 for middle-aged and 0.94 for older adults. No significant association was found with cardiovascular mortality. Findings were consistent across subgroups.
SHR showed a U-shaped association with all-cause mortality in middle-aged and older adults with NAFLD. Monitoring SHR may help identify high-risk individuals and guide clinical management.
应激性高血糖比率（SHR）是反映应激状态下相对高血糖的一个指标，已被证明与各种临床环境中的不良预后相关。然而，其在非酒精性脂肪性肝病（NAFLD）患者中的预后意义仍知之甚少。本研究旨在探讨SHR与NAFLD成年患者死亡风险之间的关联。
我们分析了1999 - 2018年美国国家健康与营养检查调查（NHANES）数据库中的12604例NAFLD成年患者。采用多变量Cox比例风险模型、限制性立方样条（RCS）分析和Fine - Gray竞争风险模型来评估SHR与全因死亡率和心血管死亡率之间的关联。
在平均99.26个月的总体随访期内，40 - 59岁和≥60岁的成年人中，SHR与全因死亡率之间呈现U型关系。在SHR水平较低和较高时风险均增加，中年人的阈值为0.89，老年人的阈值为0.94。未发现与心血管死亡率有显著关联。各亚组的研究结果一致。
在患有NAFLD的中年和老年成年人中，SHR与全因死亡率呈U型关联。监测SHR可能有助于识别高危个体并指导临床管理。
