PACULit Daily Literature Update: Stress hyperglycemia ratio as a biomarker for early mortality risk stratification in cardiovascular disease a propensity matched analysis Quiz

John is a 72-year-old male admitted to the ICU with acute decompensated heart failure and a history of type 2 diabetes mellitus and chronic kidney disease stage 3. His admission labs show a blood glucose of 220 mg/dL and an estimated average glucose (based on HbA1c) of 140 mg/dL, yielding a stress hyperglycemia ratio (SHR) above 1.355. He is currently on metformin 500 mg twice daily and lisinopril 20 mg daily. The ICU team requests pharmacist input on prognostic indicators to guide early management decisions.

Based on the recent evidence regarding SHR in critically ill cardiovascular patients, what is the most appropriate pharmacist recommendation regarding the use of SHR in John’s care?

Advise that an elevated SHR indicates increased early mortality risk and recommend close glycemic monitoring and multidisciplinary coordination during the acute ICU phase.
Recommend discontinuing metformin immediately due to high SHR and switching to insulin therapy without further risk stratification.
Inform the team that SHR is not useful for mortality prediction and focus only on traditional severity scores like OASIS or SAPSII.
Suggest that SHR predicts long-term mortality risk and prioritize outpatient diabetes management post-discharge.

Maria is a 65-year-old female admitted to the ICU with acute coronary syndrome complicated by cardiogenic shock. She has no prior history of diabetes. Her admission labs reveal a blood glucose of 180 mg/dL and an estimated average glucose of 120 mg/dL, resulting in an SHR of approximately 1.5. The ICU team uses OASIS and SAPSII scores for mortality risk prediction and asks if SHR should be incorporated.

What is the best pharmacist advice regarding the addition of SHR to conventional severity scores for mortality risk prediction in Maria’s case?

Recommend adding SHR to OASIS and SAPSII scores to improve short-term mortality prediction, especially in-hospital and 28-day outcomes.
Advise against adding SHR as it does not improve predictive accuracy for any mortality time points.
Suggest using SHR only for predicting 90-day and 365-day mortality, not short-term outcomes.
Recommend replacing OASIS and SAPSII scores entirely with SHR for mortality prediction.

David is a 70-year-old male with a history of hypertension and no diabetes, admitted to the ICU for severe atrial fibrillation with rapid ventricular response. His admission glucose is 150 mg/dL, and estimated average glucose is 140 mg/dL, resulting in an SHR of 1.07. The ICU team is uncertain how to interpret this SHR value in relation to mortality risk and asks the pharmacist for guidance.

How should the pharmacist interpret David’s SHR value in the context of mortality risk based on the recent study findings?

An SHR below 1.355 suggests lower early mortality risk; thus, standard monitoring is appropriate without additional interventions.
Any SHR above 1.0 indicates high mortality risk and warrants aggressive glycemic control immediately.
SHR values have a U-shaped relationship with mortality, so both very low and very high SHR values increase risk; David’s SHR is near optimal and low risk.
SHR is not validated in atrial fibrillation patients and should not be used for risk stratification.

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