Stress hyperglycemia ratio association with all-cause mortality in critically ill patients with coronary heart disease: an analysis of the MIMIC-IV database

Abstract

Background The stress hyperglycemia ratio (SHR) indicates relative hyperglycemia levels. Research on the impact of SHR on mortality in coronary heart disease (CHD) patients in intensive care is limited. This study explores the predictive accuracy of SHR for the prognosis of CHD patients in the ICU. Methods This study included 2,059 CHD patients from the American Medical Information Mart for Intensive Care (MIMIC-IV) database. SHR was determined using the formula: SHR = (admission glucose) (mmol/L) / (1.59 * HbA1c [%] - 2.59). Subjects were stratified into quartiles based on SHR levels to examine the correlation between SHR and in-hospital mortality. The restricted cubic splines and Cox proportional hazards models were employed to assess this association, while Kaplan-Meier survival analysis was executed to ascertain the mortality rates across the SHR quartiles. Results Among the 2059 participants (1358 men), the rates of in-hospital and ICU mortality were 8.5% and 5.25%, respectively. Analysis showed SHR as a significant predictor of increased risk for both in-hospital (HR,1.16, 95% CI: 1.02-1.32, P = 0.022) and ICU mortality (HR, 1.16, 95% CI: 1.01-1.35, P = 0.040) after adjustments. A J-shaped relationship was noted between SHR and mortality risks (p for non-linearity = 0.002, respectively). Kaplan-Meier analysis confirmed substantial differences in in-hospital and ICU mortality across SHR quartiles. Conclusions SHR significantly predicts in-hospital and ICU mortality in critically ill CHD patients, indicating that higher SHR levels correlate with longer ICU stays and increased mortality. This underscores the potential of SHR as a prognostic marker for ICU CHD patients.

Keywords: Coronary heart disease; MIMIC-IV database; Mortality; Stress hyperglycemia ratio.

Fig. 1

Flow chart of patient selection.

Fig. 2

Kaplan–Meier survival analysis curves for all-cause mortality. Footnote SHR quartiles: Q1: 0.19–0.88; Q2: 0.88–1.07; Q3: 1.07–1.37; Q4: 1.37–15.09. Kaplan–Meier curves showing probability of hospital mortality according to groups at 1 month (A), and 3 months (B), and ICU mortality according to groups at 1 month (C), and 3 months (D).

Fig. 3

Restricted cubic spline curve for the SHR hazard ratio. A Restricted cubic spline for hospital mortality. B Restricted cubic spline for ICU mortality. HR, hazard ratio; CI, confdence interval; ICU, intensive care unit; SHR, stress hyperglycemia ratio.

Fig. 4

Forest plots of hazard ratios for the primary endpoint in different subgroups. HR, hazard ratio; CI, confidence interval; BMI, body mass index; HBP, hypertension; AMI, acute myocardial infarction; CKD, chronic kidney disease; HF heart failure; AF atrial fibrillation.