Stress hyperglycemia ratio and in-hospital prognosis in non-surgical patients with heart failure and type 2 diabetes

Zhou, Yiling; Liu, Li; Huang, Hongmei; Li, Nan; He, Julong; Yao, Heling; Tang, Xiaochi; Chen, Xiangyang; Zhang, Shengzhao; Shi, Qingyang; Qu, Furong; Wang, Si; Wang, Miye; Shu, Chi; Zeng, Yuping; Tian, Haoming; Zhu, Ye; Su, Baihai; Li, Sheyu

doi:10.1186/s12933-022-01728-w

Cited by 21 publications

(22 citation statements)

References 34 publications

(57 reference statements)

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“…Notably, the U-shaped or J-shaped association was not significant in the subgroup of patients without diabetes, consistent with our findings [ 8 ]. Moreover, Zhou et al found a U-shaped association between SHR and in-hospital cardiac, kidney, and infectious adverse events in non-surgical hospitalized patients with type 2 diabetes and heart failure [ 32 ]. In addition, one study consisting of 3750 AMI patients admitted to 35 hospitals in Japan found that severe hyperglycemia (glucose ≥ 11 mmol/L) and euglycemia (glucose < 7 mmol/L) was associated with higher mortality compared to moderate hyperglycemia (glucose 9 to 11 mmol/L) in patients with a history of diabetes.…”

Section: Discussionmentioning

confidence: 99%

Prognostic implication of stress hyperglycemia in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Wang

Cao

et al. 2023

Cardiovasc Diabetol

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Background It is now understood that stress hyperglycemia is associated with adverse outcomes in hospitalized patients. Herein, we aimed to investigate the association between stress hyperglycemia and mortality risk in acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI). Methods This cohort study comprised 5190 ACS patients who underwent PCI from the Cardiovascular Center Beijing Friendship Hospital Database Bank (CBDBANK) from January 2013 to January 2021. Stress hyperglycemia was defined by the glucose/glycated albumin (GA) ratio, calculated as admission fasting plasma glucose divided by GA. The patients were divided into four groups according to glucose/GA ratio quartiles (Q1-Q4). Cox proportional hazards regression and restricted cubic spline were used to evaluate the association between glucose/GA ratio and all-cause and cardiovascular mortality. Results During a median follow-up of 4.0 years, the number of all-cause deaths was 313 (6.0%) and cardiovascular-associated deaths was 177 (3.4%). After adjustment for potential confounders, the risk of all-cause mortality increased in the lowest (HR, 1.43; 95% CI, 1.01–2.03) and highest (HR, 1.51; 95% CI, 1.03–2.21) glucose/GA ratio quartiles compared to Q2. The restricted cubic splines showed that the association between glucose/GA ratio and all-cause mortality was U-shaped after full adjustment (Pnonlinear = 0.008). Similar results were observed for cardiovascular mortality. In subgroup analyses according to diabetes status, the U-shaped relationship was only significant in patients with diabetes mellitus. Conclusion In ACS patients undergoing PCI, low and high glucose/GA ratio values were associated with an increased all-cause and cardiovascular mortality, especially in those with diabetes mellitus.

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Section: Discussionmentioning

confidence: 99%

Prognostic implication of stress hyperglycemia in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Wang

Cao

et al. 2023

Cardiovasc Diabetol

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“…While stress hyperglycemia may not potentially distinguish among diverse causes of absolute hyperglycemia, SHR is a combined measure of a patient’s acute-phase and chronic glycemia values, it reflects the true stress hyperglycemia state and has been found to be a potential determinant of adverse risk in multiple cardiovascular diseases [ 32 ]. Zhou et al found that both high and low SHR indicate a poor prognosis in patients with HF and type 2 diabetes during hospitalization [ 22 ]. In a recent study, a U-shaped association was identified between the SHR and all-cause, cardiac death, and HF readmission in individuals with acute decompensated HF and diabetes after a 3-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have assessed its role across various cardiovascular diseases, indicating its potential as a predictor of future risk, regardless of diabetes presence [ 18 – 21 ]. While recent studies have explored the impact of SHR on short- and long-term outcomes in diabetic HF patients, there is no data on its specific impact on the long-term prognosis of HFpEF, encompassing both diabetic and non-diabetic individuals [ 22 , 23 ]. Consequently, there is a need to clarify the potential role of SHR within clinical risk strategies for patients with HFpEF.…”

Section: Introductionmentioning

confidence: 99%

Stress hyperglycemia ratio as a prognostic indicator for long-term adverse outcomes in heart failure with preserved ejection fraction

Mohammed,

Luo,

Wang

et al. 2024

Cardiovasc Diabetol

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Background Recent studies highlighted that stress hyperglycemia ratio (SHR) is a potential predictor for future risk in heart failure (HF) patients. However, its implications specifically in HF with preserved ejection fraction (HFpEF) are not yet fully elucidated. We aimed to investigate the association between SHR and long-term clinical outcomes in HFpEF patients. Methods HFpEF patients enrolled between 2015 and 2023, were followed (mean 41 months) for a composite outcome of all-cause, cardiovascular mortality, and HF rehospitalization. SHR was established as the ratio of acute-chronic glycemia from admission blood glucose and glycated hemoglobin. The optimal cut-off for SHR to predict outcomes based on event prediction was determined through ROC analysis, and the cutoff was identified at 0.99. The effect of SHR on adverse risk was examined through the Cox hazards and Kaplan-Meier survival methods. A Pearson correlation analysis was conducted to assess the relationship between SHR and the severity of HF, as indicated by N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Furthermore, the incremental prognostic value of SHR was further assessed by the integrated discrimination improvement (IDI) and the net reclassification improvement (NRI). Results Among the 400 enrolled patients, 190 individuals (47.5%) encountered composite events over the 41-month follow-up period. SHR was significantly elevated in patients with events compared with those without (p < 0.001). All patients were stratified into high SHR (n = 124) and low SHR (n = 276) groups based on the SHR cutoff. The high SHR group had a significantly higher incidence of adverse events than the low SHR group (log-rank; p < 0.001). Additional analysis indicated a poorer prognosis in patients with low left ventricular EF (LVEF) levels (50 < LVEF < 60) and high SHR (SHR > 0.99) in comparison to the other groups (log-rank p < 0.001). In adjusted analysis, after accounting for age, sex, diabetes, and NT-proBNP, elevated SHR remained independently predictive of adverse outcomes (adjusted HR: 2.34, 95% CI 1.49–3.67; p < 0.001). Furthermore, adding SHR to a model with MAGGIC score provided an incremental improvement in predicting adverse events. Additionally, SHR displayed a slight correlation with NT-proBNP. Conclusion Elevated SHR was independently associated with an increased risk for composite events of all-cause, cardiovascular mortality, and HF readmission than those with lower SHR. SHR is a valuable tool for predicting and stratifying long-term adverse risks among HFpEF patients.

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“…Further studies indicate that SHR is independently associated with short-term and long-term adverse outcomes in acute coronary syndrome (ACS) and short-term adverse outcomes in acute myocardial infarction (AMI) [ 8 – 13 ]. A study involving 2875 Chinese adults with type 2 diabetes and heart failure found that both higher and lower SHR patients had poor prognoses [ 14 ]. Regarding the correlation between SHR and cerebrovascular diseases, a two-center prospective study showed that after adjusting for covariates, for each 1-unit increase in SHR, the risk of early hematoma expansion in spontaneous intracerebral hemorrhage (ICH) patients increased by 16.535 times (95% CI: 3.572–76.543, p < 0.001), indicating an independent correlation between SHR and early hematoma expansion in ICH patients.…”

Section: Introductionmentioning

confidence: 99%

Association between stress hyperglycemia ratio and diabetes mellitus mortality in American adults: a retrospective cohort study and predictive model establishment based on machine learning algorithms (NHANES 2009–2018)

Yan,

Zhao,

Quan

et al. 2024

Diabetol Metab Syndr

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Background Stress hyperglycemia is a physiological response of the body under stress to make adaptive adjustments in response to changes in the internal environment. The stress hyperglycemia ratio (SHR) is a new indicator after adjusting the basal blood glucose level of the population. Previous studies have shown that SHR is associated with poor prognosis in many diseases, such as cardiovascular and cerebrovascular diseases and delirium in elderly patients. However, there are currently no studies on the correlation between SHR and the general U.S. population. The purpose of this study was to examine the association between SHR and adverse outcomes among adults in the United States in general. Methods Data on 13,315 follow-up cohorts were extracted from NHANES. The study population was divided into four groups according to quartiles of SHR. The primary outcomes were all-cause mortality and diabetes mellitus mortality. The relationship between SHR and outcomes was explored using restricted cubic splines, COX proportional hazards regression, Kaplan-Meier curves, and mediation effects. SHR is incorporated into eight machine learning algorithms to establish a prediction model and verify the prediction performance. Results A total of 13,315 individual data were included in this study. Restricted cubic splines demonstrated a “U-shaped” association between SHR and all-cause mortality and diabetes mellitus mortality, indicating that increasing SHR is associated with an increased risk of adverse events. Compared with lower SHR, higher SHR was significantly associated with an increased risk of all cause mortality and diabetes mellitus mortality (HR > 1, P < 0.05). The mediating effect results showed that the positively mediated variables were segmented neutrophils and aspartate aminotransferase, and the negatively mediated variables were hemoglobin, red blood cell count, albumin, and alanine aminotransferase. The ROC of the eight machine learning algorithm models are XGBoost (0.8688), DT (0.8512), KNN (0.7966), RF (0.8417), Logistic regression (0.8633), ENET (0.8626), SVM (0.8327) and MLP (0.8662). Conclusion SHR can be used as a predictor of all cause mortality and diabetes mellitus mortality in the general adult population in the United States. Higher SHR is significantly associated with an increased risk of poor prognosis, especially in those aged < 65 years and in women.

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Stress hyperglycemia ratio and in-hospital prognosis in non-surgical patients with heart failure and type 2 diabetes

Cited by 21 publications

References 34 publications

Prognostic implication of stress hyperglycemia in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Prognostic implication of stress hyperglycemia in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Stress hyperglycemia ratio as a prognostic indicator for long-term adverse outcomes in heart failure with preserved ejection fraction

Association between stress hyperglycemia ratio and diabetes mellitus mortality in American adults: a retrospective cohort study and predictive model establishment based on machine learning algorithms (NHANES 2009–2018)

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