Stress hyperglycemia ratio as a biomarker for early mortality risk stratification in cardiovascular disease: a propensity-matched analysis
Main finding · In-hospital mortality after PSM (Model 1)Result — go to the resultHazard ratio 2.117 95% CI 1.223–3.665Authors' conclusion
Elevated SHR contributes to early mortality in patients with cardiovascular disease, even after rigorous confounder adjustment. The incremental predictive value of SHR support its utility for risk stratification, particularly for short-term outcomes, but its prognostic value fades for long-term mortalities. These findings highlight SHR as a favorable biomarker for clinical decision-making in acute cardiovascular care.
Study context
- Population
- Critically ill patients with CVD admitted to intensive care units (ICUs) of Beth Israel Deaconess Medical Center, stratified by stress hyperglycemia ratio (SHR) quartiles (Q1-Q4)
- Participants
- 3,352 patients670 matched pairs
- Exposure
- High SHR vs low SHR
- Outcome
- All-cause mortality (in-hospital, 28-day, 90-day, 365-day)
Methodological detailspropensity-score matched, single-centre ICU database
- Propensity-score matched
- Single-centre ICU database
Main finding
In-hospital mortality after PSM (Model 1)
Hazard ratio
2.117
95% CI 1.223–3.665
P = 0.007
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| 28-day mortality after PSM (Model 1)Model 1, after PSM | 1.859 (1.100–3.141) | P = 0.020 | |
| 0.20.5125Hazard ratio (log scale) |
Long-term mortality after propensity score matching (PSM) (Model 1) · 90-day and 365-day
- 90-day mortality: no significant association
- P = 0.127
- 365-day mortality: no significant association
- P = 0.123
Unadjusted mortality by SHR quartile (before PSM)
- In-hospital mortality, Q4: 16.3% vs Q1-Q3: 5.1-6.4%
- P < 0.001
- 365-day mortality, Q4: 29.2% vs Q1-Q3: 15.7-16.9%
- P < 0.001
- Restricted cubic spline (RCS): U-shaped mortality risk, average optimal SHR cutoff 1.355
Incremental predictive value of SHR added to severity scores
- OASIS AUC gain, in-hospital mortality, before PSM
- +0.034, P < 0.001
- OASIS AUC gain, in-hospital mortality, after PSM
- +0.012, P = 0.009
- No improvement of OASIS and SAPSII for 90-day and 365-day mortality after PSM
Original publication
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