Association of stress hyperglycemia ratio with short-term and long-term prognosis in patients undergoing coronary artery bypass grafting across different glucose metabolism states: a large-scale cohort study
Authors' conclusion
SHR was significantly associated with prognosis in CABG patients, demonstrating a non-linear U-shaped relationship with short-term outcomes and a linear positive association with long-term outcomes. The in-hospital risk associated with SHR was attenuated in patients with diabetes.
Study context
- Population
- Patients undergoing isolated coronary artery bypass grafting (CABG), across glucose metabolic states (normal glucose regulation, prediabetes, diabetes)
- Participants
- 18,307 patients
- Exposure
- Stress hyperglycemia ratio (SHR) tertiles
- Outcome
- Perioperative outcome: composite of in-hospital death, MI, cerebrovascular accident and reoperation during hospitalization
- Follow-up
- In-hospital
Methodological detailslarge-scale, consecutively enrolled, subgroup analyses by glucose metabolic state
- Large-scale
- Consecutively enrolled
- Subgroup analyses by glucose metabolic state
Main finding
As reported in the abstract
U-shaped association between SHR and perioperative outcome (P for nonlinear < 0.001); inflection point
0.79
OR per SD below inflection point
0.87
95% CI 0.79–0.97P = 0.013
OR per SD above inflection point
1.16
95% CI 1.04–1.28P = 0.004
Observational data: associations, not effects.
Further findings
Perioperative composite outcome by glucose metabolic state · during hospitalization
- Similar U-shaped pattern in patients with normal glucose regulation
- J-shaped association among those with prediabetes
- In diabetes, association nonsignificant when SHR exceeded 0.76
- Subgroup analyses
Predictive performance for perioperative outcomes after adding SHR to existing risk model
- AUC
- 0.720 → 0.752, P < 0.001
- NRI
- 0.036, P = 0.003
- IDI
- 0.015, P < 0.001
Long-term major adverse cardiovascular and cerebrovascular events (MACCEs)
- Third tertile: 10.7% greater risk of MACCEs (HR)
- HR: 1.107, 95% CI 1.023-1.231, P = 0.024
- Risk monotonically elevated with increasing SHR, regardless of glucose metabolic status
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
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