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

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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

Key Findings

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

PACULit Literature Updates September 2025: Emergency Medicine & Critical Care

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