Association between stress hyperglycemia ratio and mortality in patients with heart failure complicated by sepsis

Abstract

Individuals afflicted with heart failure complicated by sepsis often experience a surge in blood glucose levels, a phenomenon known as stress hyperglycemia. However, the correlation between this condition and overall mortality remains unclear. 869 individuals with heart failure complicated by sepsis were identified from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and categorized into five cohorts based on their stress hyperglycemia ratio (SHR). The primary endpoints evaluated were mortality within the intensive care unit (ICU), all-cause mortality within 28 days, and all-cause mortality during hospitalization. Cox proportional hazards regression and restricted cubic spline analyses were employed to unravel the association between SHR and mortality. The ICU mortality, in-hospital mortality, and 28-day all-cause mortality were 10.01%, 13.69%, and 16.46%, respectively. Multivariable Cox proportional hazards regression analysis revealed a significant association between elevated SHR and all-cause mortality. After adjusting for confounding variables, elevated SHR was significantly associated with increased risk of ICU mortality (hazard ratio [HR] = 1.67; 95% confidence interval [CI], 1.03-2.70)), in-hospital mortality (HR = 1.53; 95% CI, 1.00-2.33)), and 28-day all-cause mortality (HR = 1.49; 95% CI, 1.02-2.17)). Restricted cubic spline analysis demonstrated a significant U-shaped relationship between SHR and the risk of all-cause mortality. This study revealed that stress hyperglycemia ratio is an independent prognostic factor in patients with heart failure complicated by sepsis. Notably, both very high and very low SHR values were associated with increased mortality risk.

Keywords: Heart failure; MIMIC-IV; Mortality; Sepsis; Stress hyperglycemia ratio.

Fig. 1

Flow chart illustrating the process of patient selection in MIMIC-IV. MIMIC-IV, the Medical Information Mart in Intensive Care-IV. ICU, intensive care unit; HbA1c, glycosylated hemoglobin A1c. SHR, stress hyperglycemia ratio.

Fig. 2

Kaplan–Meier survival analysis curves for 28-day all-cause mortality based on distinct groups. Footnote SHR groups: SHR_G1 (< 0.70), SHR_G2 (0.70–0.99), SHR_G3 (1.00-1.29), SHR_G4 (1.30–1.59), SHR_G5 (≥ 1.60).

Fig. 3

Restricted cubic spline curve for the SHR hazard ratio. Red central lines represent the estimated hazard ratios, with shaded ribbons denoting 95% confidence intervals. SHR 1.08 was selected as the reference level represented by the vertical dotted lines. The horizontal dotted lines represent the hazard ratio of 1.0. (a) Restricted cubic spline for ICU mortality. (b) Restricted cubic spline for hospital mortality. (c) Restricted cubic spline for 28-day mortality. HR, hazard ratio; CI, confidence interval; ICU, intensive care unit; SHR, stress hyperglycemia ratio.

Fig. 4

Forest plots of hazard ratios for the ICU mortality in different subgroups. Adjusted for age, temperature, oxygen saturation, cerebrovascular disease, dementia, renal disease, mild liver disease, urine output, antibiotic use, SOFA score, SAPS II, APACHE III, LODS. CI, confidence interval; HR, hazard ratio; SOFA, sequential organ failure assessment; APS III, acute physiology score III; SAPS II, simplified acute physiology score II; LODS, logistic organ dysfunction system; ICU, intensive care unit.