Stress hyperglycemia ratio modulates the impact of organ dysfunction on mortality risk in critically ill patients with atrial fibrillation: insights from the MIMIC-IV database
Authors' conclusion
This study reveals a notable relationship among SHR and SOFA scores in forecasting mortality among critically sick patients with atrial fibrillation. The developed nomogram integrating SHR, SOFA, and other covariates offers a novel tool for risk stratification. SHAP analysis confirms SHR and SOFA as key predictors, highlighting their clinical utility in mortality assessment.
Study context
- Population
- Critically ill patients with atrial fibrillation (AF) in MIMIC-IV 3.1; median age 66 years (IQR: 55–76), 56.8% male
- Participants
- 15,358 patients
- Exposure
- Combined SHR-SOFA groups
- Outcome
- In-hospital, 30-day and 1-year mortality
Methodological detailsMIMIC-IV 3.1 database
- MIMIC-IV 3.1 database
Main finding
As reported in the abstract
Mortality by SHR-SOFA group
Q4Hazard ratio (95% CI)
In-hospital mortality; reference group not stated
5.32(4.31–6.57)
30-day mortality; reference group not stated
4.27(3.62–5.04)
1-year mortality; reference group not stated
3.18(2.82–3.59)
- SHR-SOFA combination stratified patients into 4 risk groups; Q4 poorest prognosis at all time points
- log-rank P < 0.001
Observational data: associations, not effects.
Further findings
Nonlinear Stress Hyperglycemia Ratio (SHR)–mortality relationship (restriction cubic splines (RCS))
- Threshold effect in low SOFA patients at SHR
- 1.0
- J-shaped curve in high SOFA patients; ideal SHR
- 1.2
Mediation by serum bicarbonate of SHR's effect on in-hospital mortality
- Proportion mediated, diminishing over time
- 22.7%
Nomogram predictors
- Nomogram included SHR, SOFA, age, MBP, WBC, bicarbonate, hemoglobin, sodium, total calcium; SHAP: SHR and SOFA most influential, age also crucial
Original publication
Stress hyperglycemia ratio modulates the impact of organ dysfunction on mortality risk in critically ill patients with atrial fibrillation: insights from the MIMIC-IV database. Cardiovasc Diabetol. Published 5 November 2025. doi:10.
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