Chen Jinzhan, Chen Ayun, Zhang Ning, Chen Zhisheng, Huang Jinxian, Jiang Hongni, Xie Congyi
Department of Pulmonary Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China.
Department of Endocrinology, The First Affiliated Hospital of Xiamen University, Xiamen, China.
J Thorac Dis. 2025 Aug 31;17(8):5466-5479. doi: 10.21037/jtd-2024-2221. Epub 2025 Aug 22.
Co-morbidity of chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2DM) corresponds to increasing severity and adverse clinical outcomes. This study intends to investigate the association of stress hyperglycemia ratio (SHR) with adverse outcomes in critically ill patients with COPD and T2DM.
Critically ill patients diagnosed with COPD and T2DM from 2008 to 2019 were retrospectively included from the Medical Information Mart for Intensive Care IV (MIMIC-IV; version 2.2). They were assigned into three groups based on SHR tertiles, and all-cause in-hospital mortality (ACIHM) and length of intensive care unit (ICU) stay (LOIS) were the primary and secondary outcomes, respectively. The association of SHR with adverse outcomes was explored by Logistic regression, generalized linear regression, and restricted cubic spline (RCS) curve analyses, and its robustness was verified by subgroup analyses.
Totally 1,781 patients with COPD and T2DM were included. Logistic regression analyses revealed that after adjusting for all confounders, the risk of ACIHM increased by 51% in T3 compared with T1 [odds ratio (OR) =1.51; 95% confidence interval (CI): 1.06-2.16]. RCS curve analyses showed a statistically significant linear association between SHR and ACIHM (P=0.58). As shown by generalized linear regression analyses, each unit increase in SHR was associated with a 0.68-day increase in LOIS after adjusting for all confounders (β=0.68; 95% CI: 0.12-1.2). According to subgroup analyses, SHR and ACIHM had no statistically significant interaction except for the marital status subgroup (P=0.04).
A high SHR is associated with an increase in ACIHM and LOIS in critically ill patients with COPD and T2DM. Assessment of SHR may contribute to better risk stratification and prognostic prediction for such patients.
慢性阻塞性肺疾病（COPD）与2型糖尿病（T2DM）的合并症与病情严重程度增加及不良临床结局相关。本研究旨在调查应激性高血糖比率（SHR）与COPD合并T2DM危重症患者不良结局之间的关联。
回顾性纳入2008年至2019年在重症监护医学信息数据库IV（MIMIC-IV；版本2.2）中诊断为COPD和T2DM的危重症患者。根据SHR三分位数将他们分为三组，全因院内死亡率（ACIHM）和重症监护病房（ICU）住院时长（LOIS）分别作为主要和次要结局。通过逻辑回归、广义线性回归和受限立方样条（RCS）曲线分析探索SHR与不良结局之间的关联，并通过亚组分析验证其稳健性。
共纳入1781例COPD合并T2DM患者。逻辑回归分析显示，在调整所有混杂因素后，与T1组相比，T3组的ACIHM风险增加了51%[比值比（OR）=1.51；95%置信区间（CI）：1.06-2.16]。RCS曲线分析显示SHR与ACIHM之间存在统计学显著的线性关联（P=0.58）。广义线性回归分析表明，在调整所有混杂因素后，SHR每增加一个单位，LOIS增加0.68天（β=0.68；95%CI：0.12-1.2）。根据亚组分析，除婚姻状况亚组外，SHR与ACIHM无统计学显著的交互作用（P=0.04）。
高SHR与COPD合并T2DM危重症患者的ACIHM增加和LOIS延长相关。评估SHR可能有助于对此类患者进行更好的风险分层和预后预测。
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