Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 28;23(1):84.
doi: 10.1186/s12933-024-02172-8.

The prognostic value of the stress hyperglycemia ratio for all-cause and cardiovascular mortality in patients with diabetes or prediabetes: insights from NHANES 2005-2018

Lei Ding #  1 , Hongda Zhang #  1 , Cong Dai  2 , Aikai Zhang  1 , Fengyuan Yu  1 , Lijie Mi  1 , Yingjie Qi  1 , Min Tang  3
Affiliations

The prognostic value of the stress hyperglycemia ratio for all-cause and cardiovascular mortality in patients with diabetes or prediabetes: insights from NHANES 2005-2018

Lei Ding et al. Cardiovasc Diabetol. .

Abstract

Background: The Stress hyperglycemia ratio (SHR) is a novel marker reflecting the true acute hyperglycemia status and is associated with clinical adverse events. The relationship between SHR and mortality in patients with diabetes or prediabetes is still unclear. This study aimed to investigate the predictive value of the SHR for all-cause and cardiovascular mortality in patients with diabetes or prediabetes.

Methods: This study included 11,160 patients diagnosed with diabetes or prediabetes from the National Health and Nutrition Examination Survey (2005-2018). The study endpoints were all-cause and cardiovascular mortality, and morality data were extracted from the National Death Index (NDI) up to December 31, 2019. Patients were divided into SHR quartiles. Cox proportion hazards regression was applied to determine the prognostic value of SHR. Model 1 was not adjusted for any covariates. Model 2 was adjusted for age, sex, and race. Model 3 was adjusted for age, sex, race, BMI, smoking status, alcohol use, hypertension, CHD, CKD, anemia, and TG.

Results: During a mean follow-up of 84.9 months, a total of 1538 all-cause deaths and 410 cardiovascular deaths were recorded. Kaplan-Meier survival analysis showed the lowest all-cause mortality incidence was in quartile 3 (P < 0.001). Multivariate Cox regression analyses indicated that, compared to the 1st quartile, the 4th quartile was associated with higher all-cause mortality (model 1: HR = 0.89, 95% CI 0.74-10.7, P = 0.226; model 2: HR = 1.24, 95% CI 1.03-1.49, P = 0.026; model 3: HR = 1.30, 95% CI 1.08-1.57, P = 0.006). The 3rd quartile was associated with lower cardiovascular mortality than quartile 1 (model 1: HR = 0.47, 95% CI 0.32-0.69, P < 0.001; model 2: HR = 0.66, 95% CI 0.45-0.96, P = 0.032; model 3: HR = 0.68, 95% CI 0.46-0.99, P = 0.049). There was a U-shaped association between SHR and all-cause mortality and an L-shaped association between SHR and cardiovascular mortality, with inflection points of SHR for poor prognosis of 0.87 and 0.93, respectively.

Conclusion: SHR is related to all-cause and cardiovascular mortality in patients with diabetes or prediabetes. SHR may have predictive value in those patients.

Keywords: All-cause mortality; Cardiovascular mortality; Diabetes; Prediabetes; Stress hyperglycemia ratio (SHR).

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the sample selection from NHANES 2005–2018
Fig. 2
Fig. 2
K-M analyses for all-cause mortality among the four groups. Q1–Q4 quartiles 1–4, SHR stress hyperglycemia ratio
Fig. 3
Fig. 3
Association between the SHR and all-cause (A) and cardiovascular mortality (B) in patients with diabetes or prediabetes. Adjusted for age, sex, race, BMI, smoking status, alcohol use, hypertension, coronary heart disease, chronic kidney disease, anemia, and TG. The solid line and purple area represent the estimated values and their corresponding 95% CIs, respectively. SHR stress hyperglycemia ratio; BMI body mass index; CI confidence interval; HR hazard ratio, TG triglyceride
Fig. 4
Fig. 4
Association between SHR and all-cause (A) and cardiovascular mortality (B) in patients with diabetes. Association between SHR and all-cause (C) and cardiovascular mortality (D) in patients with pre-diabetes. Adjusted for age, sex, race, BMI, smoking status, alcohol use, hypertension, coronary heart disease, chronic kidney disease, anemia, and TG. The solid line and purple area represent the estimated values and their corresponding 95% CIs, respectively. SHR stress hyperglycemia ratio; BMI body mass index; CI confidence interval; HR hazard ratio, TG triglyceride
See this image and copyright information in PMC

References

    1. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, Stein C, Basit A, Chan JCN, Mbanya JC, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. doi: 10.1016/j.diabres.2021.109119. - DOI - PMC - PubMed
    1. Chi ZS, Lee ET, Lu M, Bennett PH, Group tWMS Vascular disease prevalence in diabetic patients in China: standardised comparison with the 14 centres in the WHO multinational study of Vascular Disease in Diabetes. Diabetologia. 2001;44:82–S86. doi: 10.1007/PL00002944. - DOI - PubMed
    1. Forouhi NG, Sattar N, Tillin T, McKeigue PM, Chaturvedi N. Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK. Diabetologia 2006, 49(11):2580–2588. - PubMed
    1. van Susan D, Beulens JWJ, Yvonne T, van der Grobbee S, Nealb DE. The global burden of diabetes and its complications: an emerging pandemic. Eur J Cardiovasc Prev Rehabilitation. 2010;17(1suppl):3–s8. doi: 10.1097/01.hjr.0000368191.86614.5a. - DOI - PubMed
    1. Raghavan S, Vassy JL, Ho YL, Song RJ, Gagnon DR, Cho K, Wilson PWF, Phillips LS. Diabetes Mellitus–related all-cause and Cardiovascular Mortality in a national cohort of adults. J Am Heart Association 2019, 8(4). - PMC - PubMed

Publication types