Association between the stress hyperglycemia ratio and all-cause mortality in critically ill patients with Acute Ischemic Stroke: a retrospective cohort study

Abstract

Background The Systolic Hypertension Ratio (SHR) is established as a reliable marker for assessing the severity of stress-induced hyperglycemia. While its effectiveness in managing critical ill patients with Acute Ischemic Stroke (AIS) remains to be fully understood. We aim to explore the relationship between SHR and clinical prognosis in critically ill AIS patients and to assess how diabetes status influences this relationship. Methods In this study, we analyzed data from the Medical Information Mart for Intensive Care (MIMIC-IV) database, selecting patients with severe AIS who required ICU admission. These patients were categorized into quartiles based on their SHR levels. We applied Cox hazard regression models and used restricted cubic spline (RCS) curves to investigate relationships between outcomes and SHR. Results The study enrolled a total of 2029 patients. Cox regression demonstrated that a strong correlation was found between increasing SHR levels and higher all-cause mortality. Patients in the highest two quartiles of SHR experienced significantly elevated 30-day and 90-day mortality rates compared to those in the lowest quartile. This pattern remained consistent regardless of diabetes status. Further, RCS analysis confirmed a progressively increasing risk of all-cause mortality with higher SHR levels. Conclusion The findings indicate that SHR is association with increased 30-day and 90-day mortality among AIS patients, underscoring its potential value in risk stratification. Although the presence of diabetes may weaken this association, significant correlations persist in diabetic patients.