Is pulmonary vascular remodeling an intermediate link between hyperglycemia and adverse outcomes in patients with idiopathic pulmonary arterial hypertension? Insights from a multi-center cohort study
An erratum to this article was published (Cardiovasc Diabetol, 7 Nov 2025 ↗)
Authors' conclusion
SHR is positively associated with clinical worsening in patients with IPAH. The association appeared to be partially mediated through the pathway of pulmonary vascular remodeling, indicating that SHR may serve as a valuable indicator for providing additional risk information.
Study context
- Population
- Consecutive patients diagnosed with or treated for idiopathic pulmonary arterial hypertension (IPAH), January 2015–June 2023
- Participants
- 625 patients
- Exposure
- Hyperglycaemia indices and clinical worsening
- Outcome
- Clinical worsening events
- Follow-up
- Mean 3.8 years
Methodological detailsconsecutive patients
- Consecutive patients
Main finding
As reported in the abstract
All-cause death or clinical worsening events
219
35.0%
Stress hyperglycemia ratio (SHR) per 0.1-unit increment, HR
1.328
95% CI 1.185, 1.489P < 0.001
Admission blood glucose (ABG) per 1.0-unit increment, HR
1.317
95% CI 1.134, 1.529P < 0.001
Observational data: associations, not effects.
Further findings
Mediation by pulmonary vascular resistance
- Proportion of SHR–clinical worsening association mediated by PVR
- 5.65%
- Proportion of ABG–clinical worsening association mediated by PVR
- 14.62%
Correlation with IPAH severity
- Hyperglycaemia indices correlated with WHO functional class, 6-min walk distance and NT-proBNP
Incremental value of SHR
- Adding SHR significantly improved reclassification, discrimination and model fit beyond the clinical risk model
Original publication
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