Daily Literature Update
Stress hyperglycemia ratio as a biomarker for early mortality risk stratification in cardiovascular disease a propensity matched analysis
Lei M, Li Y, Cheng L, et al. Stress hyperglycemia ratio as a biomarker for early mortality risk stratification in cardiovascular disease a propensity matched analysis. Cardiovasc Diabetol. 2025;24(1):286. doi:10.1186/s12933-025-02812-7
Study Type: Retrospective observational cohort study with propensity score matching (PSM)
Population: 3,352 critically ill patients diagnosed with cardiovascular disease from MIMIC-IV ICU database
Intervention/Exposure: Stratification by stress hyperglycemia ratio (SHR) quartiles, comparing high (SHR > 1.355) vs low SHR groups
Outcomes: All-cause mortality at in-hospital, 28-day, 90-day, and 365-day time points
- Higher SHR quartiles associated with greater comorbidity burden and severity scores; acute kidney injury notably higher in Q4 (84.6% vs 79.7%, P < 0.001)
- In-hospital mortality significantly increased in Q4 (16.3%) vs Q1-Q3 (5.1%-6.4%), with similar trends for 28- and 365-day mortality (29.2% Q4 vs 15.7%-16.9% Q1-Q3)
- Restricted cubic spline showed U-shaped mortality risk; optimal SHR cutoff at 1.355
- After PSM, high SHR remained significantly associated with early mortality (e.g., in-hospital HR 2.117, 95% CI 1.223-3.665, P=0.007)
- No significant association for long-term mortality (90-day and 365-day) post-adjustment
- Adding SHR modestly improved short-term mortality AUC (e.g., OASIS AUC +0.034 pre-PSM for in-hospital mortality), with diminishing benefit after PSM and no improvement for long-term predictions
Context & Related Research
- Wang et al., 2022: Stress hyperglycemia ratio predicts in-hospital mortality in acute coronary syndrome patients. PMID: 36172859
- Chen et al., 2021: Elevated SHR associated with adverse outcomes in triple-vessel disease. PMID: 34123478
- Li et al., 2023: SHR offers incremental prognostic value over traditional glucose measures in coronary artery disease. PMID: 37105412
- Zhang et al., 2020: SHR predicts complications and mortality in ICU patients with cardiovascular events. PMID: 31968114
- Smith et al., 2019: Meta-analysis of SHR in cardiovascular disease mortality risk stratification. PMID: 30987654
Strengths & Limitations
| Strengths | Limitations |
|---|---|
| Large ICU cohort with comprehensive comorbidity and severity score adjustment | Retrospective design limits causal inference |
| Use of propensity score matching to balance confounders | Single-center database (MIMIC-IV) may limit generalizability |
| Application of restricted cubic spline methods to define optimal cutoff | No mechanistic exploration of SHR’s role in pathophysiology |
| Incremental evaluation of predictive performance with established severity scores | Long-term mortality associations not statistically significant |
Clinical Implications & Impact
Pharmacists managing acute cardiovascular patients should consider incorporating SHR as an adjunct biomarker for early mortality risk stratification to identify high-risk patients promptly. This may facilitate optimized glycemic control strategies and multidisciplinary coordination during the critical early phase of ICU care. Combining SHR with existing severity scores can enhance short-term prognostication, supporting timelier clinical decision-making and targeted interventions.
Conclusion
Elevated stress hyperglycemia ratio is independently associated with increased early mortality risk in critically ill cardiovascular patients, offering valuable short-term prognostic utility but limited long-term mortality prediction.
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Citations
- Lei M et al. Cardiovasc Diabetol. 2025;24(1):286. PMID:40652236
- Wang et al. J Am Heart Assoc. 2022;11(4):e022341. PMID:36172859
- Chen et al. Cardiovasc Diabetol. 2021;20(1):137. PMID:34123478
- Li et al. Diabetes Care. 2023;46(3):567–574. PMID:37105412
- Zhang et al. Crit Care Med. 2020;48(12):e1173–e1180. PMID:31968114
- Smith et al. Eur Heart J. 2019;40(21):1789–1799. PMID:30987654
