Stress Hyperglycemia Research Articles

The relationship of plasma glucose, stress hyperglycaemia and glycated haemoglobin with intermediate-term mortality after acute myocardial infarction in patients with and without diabetes.

Admission hyperglycaemia is an adverse prognostic indicator in the setting of acute myocardial infarction. It is unclear if this is because of previously undiagnosed diabetes, due to admission plasma glucose being a marker of a greater stress hormone response and therefore a more severe event, or due to a detrimental effect of high blood glucose on the myocardium. We performed retrospective analysis of a cohort of 430 participants admitted with a diagnosis of acute myocardial infarction. We investigated the relation of admission plasma glucose, glycated haemoglobin, stress hyperglycaemia ratio and a novel parameter; the stress hyperglycaemia index, to mortality by Cox regression analyses. The stress hyperglycaemia index is the difference between the admission glucose and glucose estimated from HbA1c. We included 430 participants who were followed for a median of 2.5 years. The stress hyperglycaemia index was associated with increased mortality in patients with diabetes in both univariate and multivariate analyses. Admission glucose was associated with mortality in subjects with diabetes in univariate analysis and after adjustment of age and sex, but not after adjusting for eGFR. There was no significant association between admission glucose and mortality in subjects without diabetes. HbA1c was not associated with mortality in either patient group in both univariate and multivariate analyses. Our results suggest a possible detrimental effect of hyperglycaemia in the setting of an acute myocardial infarction.

Assessment of stress hyperglycemia ratio to predict all-cause mortality in patients with critical cerebrovascular disease: a retrospective cohort study from the MIMIC-IV database

BackgroundThe association between the stress hyperglycemia ratio (SHR), which represents the degree of acute stress hyperglycemic status, and the risk of mortality in cerebrovascular disease patients in the intensive care unit (ICU) remains unclear. This study aims to investigate the predictive ability of SHR for in-hospital mortality in critically ill cerebrovascular disease patients and to assess its potential to enhance existing predictive models.MethodsWe extracted data from the Medical Information Mart for Intensive Care (MIMIC-IV) database for patients diagnosed with cerebrovascular disease and used Cox regression to assess the association between SHR and mortality. To investigate the nature of this association, we applied restricted cubic spline analysis to determine if it is linear. The predictive ability of SHR for mortality risk was evaluated using receiver operating characteristic (ROC) curves and the C-index.ResultsWe included a total of 2,461 patients, with a mean age of 70.55 ± 14.59 years, and 1,221 (49.61%) being female. Cox regression analysis revealed that SHR was independently associated with both in-hospital mortality (per standard deviation (SD) increase: hazard ratio (HR) 1.35, 95% confidence interval (CI) 1.23–1.48) and ICU mortality (per SD increase: HR 1.37, 95% CI 1.21–1.54). The risk of death increased in an approximately linear fashion when SHR exceeded 0.77–0.79. Subgroup analysis indicated the association was more pronounced in non-diabetic individuals. Additionally, incorporating SHR into existing models improved both discrimination and reclassification performance.ConclusionSHR serves as an independent risk factor for in-hospital mortality in cerebrovascular disease patients in the ICU. Adding SHR to existing models enhances their predictive performance, offering clinical value in the identification of high-risk patients.

The association between stress-induced hyperglycemia ratio and cardiovascular events as well as all-cause mortality in patients with chronic kidney disease and diabetic nephropathy

The stress hyperglycemia ratio (SHR) is an emerging biomarker used to assess blood glucose levels under acute stress conditions and has been linked to the incidence of adverse clinical outcomes. However, the precise role of SHR in patients with diabetic kidney disease (DKD) and chronic kidney disease (CKD), particularly in relation to mortality, remains poorly understood. This study seeks to investigate the clinical value of SHR as a predictive tool for all-cause and cardiovascular mortality in these patient groups. This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018, encompassing 3,507 individuals diagnosed with diabetic kidney disease (DKD) or chronic kidney disease (CKD). The primary endpoints included all-cause mortality and cardiovascular mortality, with mortality data obtained from the National Death Index (NDI) through December 31, 2019. Participants were categorized into quartiles based on the stress hyperglycemia ratio (SHR), and Cox proportional hazards regression models were employed to examine the association between SHR and mortality. Model 1 did not account for any covariates, Model 2 adjusted for age, sex, and race, while Model 3 additionally incorporated adjustments for educational attainment, marital status, body mass index, smoking behavior, hypertension, hyperlipidemia, and cardiovascular disease. The study comprised 3,507 patients with a mean age of 60.7 years, of whom 56% were female. The overall incidence of all-cause mortality was 38,000 per 100,000 person-years, while cardiovascular mortality was 11,405 per 100,000 person-years. Kaplan–Meier survival analysis revealed that the second quartile of the stress hyperglycemia ratio (SHR) (Q2) exhibited the lowest all-cause mortality (log-rank P = 0.003). Cox regression analysis indicated that the hazard ratio (HR) for all-cause mortality in Q2 was 0.76 (95% CI: 0.63, 0.92), whereas the HR for Q4 was 1.26 (95% CI: 1.04, 1.52). Restricted cubic spline (RCS) analysis revealed a J-shaped association between SHR and all-cause mortality, as well as a U-shaped association with cardiovascular mortality. The minimum risk values for SHR were 0.923 for all-cause mortality and 1.026 for cardiovascular mortality. In patients with diabetic kidney disease (DKD) and chronic kidney disease (CKD), SHR demonstrated a J-shaped relationship with all-cause mortality and a U-shaped relationship with cardiovascular mortality. Subgroup analyses indicated that the effect of spontaneous hypertension on mortality was consistent across all subgroups. This study highlights a significant association between the stress hyperglycemia ratio (SHR) and both all-cause and cardiovascular mortality in patients with diabetic kidney disease (DKD) or chronic kidney disease (CKD). SHR may serve as a critical biomarker for prognostic assessment in these populations, enabling clinicians to identify high-risk patients and tailor personalized treatment strategies that enhance patient quality of life and mitigate mortality risk.Graphical abstract

Retraction Note: Letter to the Editor: "Relationship between stress hyperglycemia ratio and prognosis in patients with aneurysmal subarachnoid hemorrhage: a two-center retrospective study".

Retraction Note: Letter to the Editor: "Relationship between stress hyperglycemia ratio and prognosis in patients with aneurysmal subarachnoid hemorrhage: a two-center retrospective study".

Stress hyperglycemia ratio is associated with delayed cerebrovascular ischemia and poor prognosis in patients with aneurysmal subarachnoid hemorrhage undergoing neurointerventional therapy.

Previous research has established a correlation between hyperglycemia following aneurysmal subarachnoid hemorrhage (aSAH) and the onset of delayed cerebrovascular ischemia (DCI), and influencing patient prognosis. The objective of this study was to evaluate the potential association between stress hyperglycemia ratio (SHR) and both the occurrence of DCI and prognosis in patients with aSAH undergoing neurointervention. We retrospectively analyzed 214 patients with aSAH undergoing neurointervention. The outcomes evaluated were DCI and 90-days poor prognosis (Modified Rankin Scale, mRS >2). The association between SHR level and both DCI and prognosis was analyzed. Stress hyperglycemia was assessed using SHR, calculated as: SHR = admission fasting plasma glucose (FPG, mmol/L) / [1.59 * hemoglobin A1c (HbA1c%) - 2.59]. Among the 214 patients, 59 (27.6 %) experienced DCI, and 60 (28 %) had a poor prognosis. Following adjustments for confounding factors, SHR emerged as an independent risk factor of both DCI (p = 0.006) and poor prognosis (p = 0.020), individuals in the T3 tertile of SHR had a higher risk of DCI than those in the T1 tertile [odds ratio (OR) 2.68; 95 % CI (1.19-6.06); p = 0.018], and individuals in the T3 tertile of SHR had a higher risk of poor 90-day prognosis than those in the T1 tertile [OR 2.47; 95 % CI (1.08-5.63); p = 0.032]. SHR was found to be a significant and independent risk factor for DCI and 90-days poor prognosis in patients with aSAH who underwent neurointerventional therapy.

Predicting Delirium in Older Adults with Community-Acquired Pneumonia: A Retrospective Analysis of Stress Hyperglycemia Ratio and Its Interactions with Nutrition and Inflammation

Community-acquired pneumonia (CAP) increases mortality risk in older patients, often complicated by delirium. Key risk factors include malnutrition and glucose metabolism disorders. This study examines the Stress Hyperglycemia Ratio (SHR) as a predictive marker for delirium in older CAP patients and its role in clinical risk management. In this retrospective study, we analyzed patients aged 65 and older diagnosed with CAP at the Second People's Hospital of Lianyungang. Delirium was evaluated using the Confusion Assessment Method (CAM) based on DSM-5 criteria. We assessed clinical data, including nutritional status, SHR, and Interleukin-6 (IL-6) levels. Nutritional status was measured using the Mini Nutritional Assessment Short Form (MNA-SF). Statistical analyses including logistic regression, Receiver Operating Characteristic (ROC) analysis, and mediation analyses were used to ascertain the predictive value of SHR and its interaction with other delirium risk factors. The average age of the cohort was 84.20 ± 5.15 years, with a delirium incidence of 19.68 % and a 28-day mortality rate of 11.16 %. Both SHR and IL-6 were significant risk factors for delirium, while higher MNA-SF scores were protective. An SHR of 1.12 or greater indicated an elevated risk of delirium. Combined assessments of SHR, IL-6, and MNA-SF enhanced predictive accuracy, achieving an AUC of 0.723. SHR and IL-6 independently and synergistically influenced the relationship between nutritional status and delirium onset. SHR is a crucial risk factor for delirium in older CAP patients, interacting with nutritional and inflammatory markers. Integrating SHR with nutritional and inflammatory assessments can enhance early risk identification and improve clinical outcomes for this vulnerable group.

The prognostic impact of the Stress Hyperglycemia Ratio on End-Stage Renal Disease among patients with Diabetic Kidney Disease.

The Stress Hyperglycemia Ratio (SHR), a new biomarker calculated from glucose and HbA1c levels, has been linked to significant clinical outcomes in diabetes. This study investigates the potential of the SHR to predict End-Stage Renal Disease (ESRD) among patients with Diabetic Kidney Disease (DKD). We included 316 participants from the West China Hospital T2DM-DKD cohort (January 2008-September 2020), divided into three SHR tertiles: T1 (SHR <0.7), T2 (SHR ≥0.7 to <0.94) and T3 (SHR ≥0.94). A second retrospective cohort of 625 DKD patients was recruited from Sichuan University Hospital (January 2019-May 2022), with similar inclusion criteria. SHR was analysed using Restricted Cubic Spline, Kaplan-Meier curves and Cox proportional hazards models. Key confounders such as eGFR, proteinuria, hypoalbuminemia and glucose-lowering medications were adjusted for in the analysis. In Cohort 1 (median follow-up 42 months), 38.6% developed ESRD. Kaplan-Meier curves showed a higher incidence of ESRD in the lowest and highest SHR tertiles compared to the middle group (p < 0.01). Multivariate analysis confirmed that SHR <0.7 (HR 1.71, 95% CI: 1.01-2.90) and SHR ≥0.94 (HR 1.93, 95% CI: 1.16-3.20) were significantly associated with ESRD. In Cohort 2 (median follow-up 18.6 months), patients with SHR <0.7 and ≥0.94 had significantly higher risks of ≥30% eGFR decline or ESRD, with adjusted HRs of 2.18 (95% CI: 1.15-4.11) and 2.68 (95% CI: 1.38-5.23), respectively. This study observed a U-shaped relationship between SHR and ESRD in patients with DKD. Both very high and very low SHR values correlate with increased risks, highlighting the critical importance of glucose management in chronic diabetes care.

Stress hyperglycemia ratio as an important predictive indicator for severe disturbance of consciousness and all-cause mortality in critically ill patients with cerebral infarction: a retrospective study using the MIMIC-IV database

BackgroundStress hyperglycemia ratio (SHR) has been linked to prognosis of cerebrovascular diseases. Nevertheless, the association between SHR and severe disturbance of consciousness (DC) and mortality among patients with cerebral infarction remains explored. This study seeks to assess the predictive potential of SHR for severe DC and mortality among patients with cerebral infarction.MethodsWe identified individuals diagnosed with cerebral infarction within the MIMIC-IV database. We employed logistic regression to examine the correlation between the SHR index and the severity of patients' consciousness disturbance, as well as in-hospital mortality. Furthermore, we employed restricted cubic spline curves to explore potential non-linear relationships between the SHR index and outcome measures. To assess the predictive performance of the SHR index and admission blood sugar level on outcome indicators, we compared receiver operating characteristic (ROC) curves.ResultsA non-linear relationship existed between SHR and the risk of severe disturbance of consciousness, while there was a linear relationship with all-cause mortality. The AUC value for predicting severe disturbance of consciousness by the SHR index is 0.5419 (95% CI: 0.5188–0.5661). The AUC value for predicting in-hospital mortality based on the SHR index is 0.6264 (95% CI: 0.5881–0.6662). It is superior to single admission blood sugar level. In addition, SHR has an incremental impact on evaluating various diseases in predicting severe disturbance of consciousness and all-cause mortality in critically ill patients with cerebral infarction.ConclusionsSHR is an important predictive indicator for severe disturbance of consciousness and all-cause mortality of patients with cerebral infarction.Graphical

Relationship between stress hyperglycemia ratio and progression of non target coronary lesions: a retrospective cohort study

BackgroundStress hyperglycemia ratio is a novel indicator of acute coronary synthesis (ACS), which is closely related to the severity and complications of ACS and other cardiovascular diseases. However, its relationship with the progression of non target coronary lesions remains unclear. The purpose of this paper is to explore the relationship between stress hyperglycemia ratio and the progression of non target coronary lesions.MethodsThis study retrospectively enrolled patients diagnosed with acute coronary syndrome who underwent stent implantation and follow-up evaluations by coronary angiography at Zhongda Hospital between January 2019 and January 2024. Patients were classified into progression and non progression groups based on follow-up angiography findings. Logistic regression models, restricted cubic spline analysis, and machine learning algorithms (LightGBM, decision tree, and XGBoost) were utilized to analyse the relationship of stress hyperglycemia ratio and non target lesion progression.ResultsA total of 1,234 ACS patients were included; 29.1% experienced non target lesions progression. Logistic regression analysis showed that stress hyperglycemia ratio (SHR) was a risk factor for non target disease progression (P < 0.001), and after adjusting for other variables, SHR was still independently associated with non target disease progression (OR = 2.12, 95% CI: 1.30–3.44, p = 0.003). RCS analysis revealed a near-linear relationship between SHR and nontarget lesions progression (P = 0.14). With the increase of SHR, the risk of non target lesions progression continued to increase, and the risk was significant when the SHR was greater than 0.96, but tended to be stable when the SHR was greater than 1.36 (p = 0.0047). A hybrid model combining logistic regression and XGBoost yielded the best predictive performance, with an AUC of 0.78 (95% CI: 0.72–0.85), incorporating SHR, number and stenosis severity of non target lesions (NTLs), hypertension and high-density lipoprotein cholesterol (HDL-c). Subgroup analysis showed that elevated SHR was a stronger predictor of NTL progression in non-diabetic patients (OR = 3.76, p = 0.007) compared with diabetic patients (OR = 1.69, p = 0.083).ConclusionStress hyperglycemia ratio is closely related to the progression of non target lesions. This study provides a novel insight for optimizing the long-term management of non target lesions after PCI.

Systematic Review and Meta-Analysis of Risk Factors Associated with Postoperative Stress Hyperglycemia in Patients without Diabetes Following Cardiac Surgery.

To systematically evaluate risk factors for stress-induced hyperglycemia in patients without diabetes after cardiac surgery. Databases including CNKI, WanFang data, VIP, SinoMed, PubMed, Web of Science, Embase, and the Cochrane Library were searched using computer retrieval. The data were subjected to an in-depth meta-analysis using RevMan 5.4 and Stata 15.0 software. This study involved 11,645 postoperative cardiac surgery patients, including 8 case-control studies and 3 cohort studies, over which 18 risk factors were identified. The results of the meta-analysis indicated that statistically significant risk factors included age >65 years [odds ratios (OR) (95% CI ) = 3.47 (2.61-4.32)], female gender [OR (95%) = 1.54 (1.34-1.76)], combined heart valve and coronary artery bypass surgery [OR (95%) = 1.82 (1.23-2.70)], ejection fraction <40% [OR (95%) = 1.38 (1.17-1.63)], history of heart surgery [OR (95%) = 1.30 (1.06-1.59)], myocardial infarction [OR (95%) = 1.17 (1.05-1.31)], hyperlipidemia [OR (95%) = 0.76 (0.67-0.86)], hypertension [OR (95%) = 1.12 (1.03-1.22)], anticoagulant medication [OR (95%) = 0.77 (0.65-0.90)], cardiopulmonary bypass time >2 hours [OR (95%) = 20.26 (17.03-23.48)] and history of cardiopulmonary bypass [OR (95%) = 1.24 (1.09-1.41)]. Current evidence suggests that there are key risk factors for postoperative stress hyperglycemia in patients without diabetes who have undergone cardiac surgery. These factors can help identify patients at a high risk of perioperative stress hyperglycemia during cardiac surgery. This evidence provides a basis for healthcare professionals to develop predictive management strategies for perioperative stress hyperglycemia in patients without diabetes. However, more high-quality studies are required to address the limitations of the current research. CRD42024479215, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=479215.

Association between stress hyperglycemia ratio and all-cause mortality in critically ill patients with sepsis: results from the MIMIC-IV database

BackgroundThis study aimed to explore the association between the stress hyperglycemia ratio (SHR) and short- and long-term outcomes in critically ill patients with sepsis.MethodsThis retrospective observational cohort study was conducted using the Medical Information Mart for Intensive Care-IV (MIMIC-IV v2.2) database. Patients were categorized into 4 SHR quartiles. The main focus was on in-hospital mortality and 1-year all-cause mortality as primary endpoints, while intensive care unit and hospital stays were considered as secondary outcomes. Regression and subgroup analyses were used to assess the correlation between SHR and the primary and secondary outcomes. Restricted cubic spline analysis was utilized to explore the nonlinear relationships between SHR and in-hospital and 1-year all-cause mortality.ResultsThis study included two groups of patients, comprising 7456 and 6564 individuals. The in-hospital and 1-year mortality was 11.96% and 17.96% in Cohort 1 and 2, respectively. SHR was associated with an elevated risk of in-hospital mortality (OR: 2.08, 95%CI 1.66–2.61) and 1-year mortality (HR: 1.70, 95% CI 1.42–2.04). Patients in SHR quartile 4 had a higher risk of in-hospital (OR: 1.86, 95% CI 1.51–2.30) and 1-year (HR: 1.44, 95% CI 1.23–1.69) mortality than those in quartile 2. Restricted cubic spline analysis showed a “J-shaped” relationship between SHR and all-cause mortality in both cohorts. The relationship between high SHR and mortality remained consistent across almost all predefined subgroups.ConclusionsOur study suggests that high SHR is associated with increased in-hospital and 1-year mortality in critically ill sepsis patients. Further investigations are needed to validate these results.

Stress hyperglycemia could influence futile recanalization in patients who undergo mechanical thrombectomy for stroke caused by large vessel occlusion.

Mechanical thrombectomy (MT) has become the standard treatment for acute ischemic stroke caused by large vessel occlusion (LVO). Despite successful recanalization, approximately one-half of the patients do not achieve a favorable outcome, which is known as "futile recanalization" (FR). The present study aimed to explore the association between stress hyperglycemia and FR after MT. Data from 224 eligible patients with LVO, who underwent MT at the authors' hospital between January 2015 and December 2023, were retrospectively reviewed. Patients were divided into FR group and non-FR groups according to functional independence at 3 months according to a modified Rankin scale. Factors influencing FR were identified using multivariate regression and a receiver operating characteristic (ROC) curve analyses. FR was observed in 40 (38.4%) of 104 patients who fulfilled the inclusion criteria. Multivariable regression analysis revealed that older age (odds ratio [OR] 1.09 [95% confidence interval (CI) 1.03-1.15]; P=0.001), an increased number of passes (OR 1.57 [95% CI 1.03-2.40]; P=0.034), and a greater stress hyperglycemia ratio (SHR) (OR 16.0 [95% CI 1.49-172.8]; P=0.021) were independently associated with FR after MT. ROC curve analysis revealed that a model of combining age, SHR, Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores, procedure duration, systolic blood pressure, and number of passes (area under the ROC curve, 0.83, [P<0.01]) was accurate. Results of this study revealed that older age, an increased number of passes, and greater SHR were independently associated with FR after MT in patients with acute ischemic stroke caused by LVO.

The impact of hyperglycemia on mortality in the emergency department: a comparison of diabetic and non-diabetic patients

Aims: Hyperglycemia is a common cause of emergency department visits and can be life-threatening. Chronic hyperglycemia results in complications including neuropathy, cardiovascular diseases, and kidney failure that are commonly found among diabetic patients while acute stress hyperglycemia induced by trauma, infection, and cardiovascular events is more often seen in non-diabetic individuals. They need to be managed in unique ways. We attempt to quantify the mortality risks of hyperglycemia in diabetic and non-diabetic emergency department patients respectively, and then use these data as a basis for management strategies. Methods: A retrospective analysis of 1,000 patients who were admitted to Esenyurt Necmi Kadıoğlu State Hospital between January 1, 2024, and June 30, 2024. Biochemical parameters and mortality were compared between diabetic and non-diabetic patients. Results: Diabetic patients had high mortality. Elevated CRP and glucose levels increase mortality risk, stress hyperglycemia was found to predict short-term risk in non-diabetic patients. The findings suggest that emergency departments should integrate hyperglycemia-related mortality risk assessment into triage protocols and consider tailored treatment strategies for diabetic and non-diabetic patients. Conclusion: This research highlights that diabetes significantly influences mortality among patients with hyperglycemia, necessitating tailored management strategies for diabetic and non-diabetic groups.

The Role of Stress Hyperglycemia on Delirium Onset.

Delirium is an acute neuropsychiatric syndrome that recognizes one or more underlying causal medical conditions. Stress hyperglycemia usually refers to transient hyperglycemia associated with stress conditions such as stroke, myocardial infarction, and major surgery. Both delirium and stress hyperglycemia share common pathways, such as activation of inflammation. Stress hyperglycemia has been associated with negative outcomes, and recent studies suggested that there is an increased risk of delirium onset in patients with stress hyperglycemia. The purpose of this review is to illustrate the relationship between stress hyperglycemia and delirium. Initially, we illustrate the role of diabetes on delirium onset, summarize the criteria used for the diagnosis of stress hyperglycemia, discuss the impact of stress hyperglycemia on outcome, and focus on the evidence about the relationship between stress hyperglycemia and delirium.

Association between stress-induced hyperglycemia ratio and sepsis risk in patients admitted to ICU.

Sepsis is a life-threatening condition characterized by a dysregulated host immune response to infection. Currently, stress hyperglycemia is frequently associated with an unfavorable prognosis in cardiovascular and cerebrovascular disease. During sepsis, the progression of the immune response and inflammation often leads to aberrant metabolic indicators. However, the association between the stress-induced hyperglycemia ratio (SHR) and sepsis in patients admitted to the intensive care unit (ICU) remains uncertain. This study aimed to explore the potential correlation between SHR and sepsis. In this retrospective cohort study, data were obtained from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Patients with recorded glucose and glycosylated HbA1c levels within 24-h ICU admission were identified. The endpoints of the follow-up period were the occurrence of sepsis during ICU stay or ICU discharge. After adjustment for factors including demographics, vital signs and biochemical indicators, the univariate and multivariate logistic regression model was employed to examine the relationship between SHR, baseline blood glucose levels and the risk of sepsis. The associations were further explored in subgroups based on age, gender and presence/absence of type 2 diabetes. Of the total 2,161 patients, with the average age of 64.96 ±16.84 years, 205 (9.49%) had sepsis. After adjustment or confounders, high SHR levels were associated with the risk of sepsis odds ratio (OR) = 1.53, 95% confidence interval (95% CI): 1.07-2.17). Similar results were found in patients aged ≥65 years (OR = 1.91, 95% CI: 1.16-3.17), in men (OR = 1.64, 95% CI: 1.02-2.63) and patients without type 2 diabetes history (OR = 1.58, 95% CI: 1.01-2.48). The baseline blood glucose level did not exhibit a significant association with the risk of sepsis. Elevated SHR levels were correlated with sepsis. Bedside monitoring of SHR may be a valuable tool for clinicians to identify patients at high risk of sepsis, and be beneficial to promptly implement clinical interventions.

Predicting 28-day all-cause mortality in patients admitted to intensive care units with pre-existing chronic heart failure using the stress hyperglycemia ratio: a machine learning-driven retrospective cohort analysis

Chronic heart failure (CHF) poses a significant threat to human health. The stress hyperglycemia ratio (SHR) is a novel metric for accurately assessing stress hyperglycemia, which has been correlated with adverse outcomes in various major diseases. However, it remains unclear whether SHR is associated with 28-day mortality in patients with pre-existing CHF who were admitted to intensive care units (ICUs). This study retrospectively recruited patients who were admitted to ICUs with both acute critical illness and pre-existing CHF from the Medical Information Mart for Intensive Care (MIMIC) database. Characteristics were compared between the survival and non-survival groups. The relationship between SHR and 28-day all-cause mortality was analyzed using restricted cubic splines, receiver operating characteristic (ROC) curves, Kaplan–Meier survival analysis, and Cox proportional hazards regression analysis. The importance of the potential risk factors was assessed using the Boruta algorithm. Prediction models were constructed using machine learning algorithms. A total of 913 patients were enrolled. The risk of 28-day mortality increased with higher SHR levels (P < 0.001). SHR was independently associated with 28-day all-cause mortality, with an unadjusted hazard ratio (HR) of 1.45 (P < 0.001) and an adjusted HR of 1.43 (P < 0.001). Subgroup analysis found that none of the potential risk factors, such as demographics, comorbidities, and drugs, affected the relationship (P for interaction > 0.05). The area under the ROC (AUC) curve for SHR was larger than those for admission blood glucose and HbA1c; the cut-off for SHR was 0.57. Patients with SHR higher than the cut-off had a significantly lower 28-day survival probability (P < 0.001). SHR was identified as one of the key factors for 28-day mortality by the Boruta algorithm. The predictive performance was verified through four machine learning algorithms, with the neural network algorithm being the best (AUC 0.801). For patients with both acute critical illness and pre-existing CHF, SHR was an independent predictor of 28-day all-cause mortality. Its prognostic performance surpasses those of HbA1c and blood glucose, and prognostic models based on SHR provide clinicians with an effective tool to make therapeutic decisions.

High-quality targeted temperature management combined with decompressive craniectomy in patients with poor-grade aneurysmal subarachnoid hemorrhage: a secondary analysis of a multicenter prospective study.

The effect of targeted temperature management (TTM) combined with decompressive craniectomy (DC) on poor-grade aneurysmal subarachnoid hemorrhage (aSAH) has not been previously addressed in the literature. This study aims to investigate the therapeutic outcomes of the combination of TTM and DC in patients with poor-grade aSAH. This study represents a secondary analysis of the Multicenter Clinical Research on Targeted Temperature Management of Poor-grade Aneurysmal Subarachnoid Hemorrhage (High-Quality TTM for PaSAH), a multicenter prospective study conducted in China. The High-Quality TTM for PaSAH study enrolled patients aged 18 years and older who were transported to the intensive care units (ICU) of three tertiary care hospitals in China between April 2022 and April 2024. Among these patients, those who underwent DC were included in the present analysis. Patients were divided into two groups: the DC-alone group and the TTM combined with the DC (TTM-DC) group. The DC-alone group maintained normothermia. The TTM-DC group used automated devices with a temperature feedback system (TFS). TTM was initiated with core temperatures between 36°C-37°C immediately after diagnosing poor-grade aSAH, and concurrent emergency aneurysm repair. This was followed by a rapid induction to 34°C-35°C, maintained for a minimum of 72 h. Subsequently, a slow rewarming process reached 36°C-37°C, which was maintained for at least 48 h. Primary outcomes were evaluated using the Modified Rankin Scale (mRS) score at 3 months. Secondary outcomes included the Glasgow Coma Scale (GCS) at discharge, ICU stay duration, length of hospitalization, proportion of external ventricular drainage (EVD), mechanical ventilation time, tracheostomy, midline shift, hydrocephalus, and delayed cerebral ischemia (DCI) on the 7th day. Safety outcomes comprised the incidence of pneumonia, myocardial infarction, stress hyperglycemia, thrombocytopenia, acute liver injury, hypokalemia, hypoproteinemia, and death at 90 days. Of the 141 patients enrolled in the High-Quality TTM for PaSAH study, 43 (25 in the TTM-DC group and 18 in the DC-alone group) were eligible for this secondary analysis. The TTM-DC group had a higher proportion of favorable outcomes (mRS 0-3: 56% vs. 22%, aOR 5.97, 95%CI 0.96-52.2, p = 0.071). After propensity score matching, the TTM combined with DC improved favorable outcome at 3 months (mRS 0-3: 61% vs. 22%, OR 5.50, 95%CI 1.36-26.3, p = 0.022). In addition, the TTM-DC group increased GCS score at discharge compared with the DC-alone group (9 vs. 3, β 2.58, 95%CI 0.32-4.84, p = 0.032). The incidence of safety outcomes was not increased in the TTM-DC group. TTM combined with DC can improve clinical conditions at discharge and ameliorate short-term neurological outcomes in poor-grade aSAH patients. TTM should be considered one of the main treatments for poor-grade aSAH patients who underwent DC.

The additive effect of the stress hyperglycemia ratio on type 2 diabetes: a population-based cohort study

BackgroundThe stress hyperglycemia ratio (SHR) has recently gained attention as a marker for acute hyperglycemia, which has been linked to adverse clinical outcomes. However, its independent role in the development of type 2 diabetes (T2D) remains understudied. This cohort study aimed to assess the association between SHR and the incidence of T2D.MethodsThe study included 8978 participants aged 45 or older, free of diabetes at baseline, from the China Health and Retirement Longitudinal Study (CHARLS). Incident T2D up to December 31, 2020, was the primary outcome. Participants were divided into SHR quartiles, and Cox proportional hazards regression and fine-gray competing risk models were used to assess SHR’s association with T2D onset, adjusting for fasting glucose and HbA1c.ResultsThe mean age of participants was 59.0 ± 9.5 years, and 51.5% were women. Over a mean follow-up of 7.8 years, 1084 participants developed T2D. Cox regression analysis revealed that individuals in the highest SHR quartile had a significantly higher risk of T2D onset compared to those in the lowest quartile (HR 1.48, 95% CI 1.26–1.75, P for trend < 0.001). Stratified analyses by sex, obesity, and smoking showed consistent results. Adding SHR to fasting glucose and HbA1c models improved the AUC for T2D prediction (DeLong Test, P = 0.013).ConclusionSHR is independently associated with incident T2D, suggesting its potential use in the risk stratification and prediction for T2D, beyond glucose and HbA1c.

Associations between stress hyperglycemia and outcomes in patients with ischemic stroke and TIA: the data comes from the Third China National Stroke Registry (CNSR-III).

Associations between stress hyperglycemia and outcomes in patients with ischemic stroke and TIA: the data comes from the Third China National Stroke Registry (CNSR-III).

Effect of Donor Stress Hyperglycemia on the Prognosis of Recipients after Pancreas-Kidney Transplantation

Effect of Donor Stress Hyperglycemia on the Prognosis of Recipients after Pancreas-Kidney Transplantation