Stress hyperglycemia ratio as a predictor of acute kidney injury and its outcomes in critically ill patients

Abstract

This study investigated stress hyperglycemia ratio (SHR) for acute kidney injury (AKI) and clinical outcomes in intensive care unit (ICU). Key outcomes were AKI within 48 h after ICU admission, acute kidney disease (AKD), ICU mortality, 28-day mortality, 90-day mortality and 1-year mortality. The associations between SHR and outcomes was estimated via logistic regression, Cox proportional hazards regression, and restricted cubic spline (RCS) analyses. Subgroup analyses assessed the consistency of these associations. Totally 3,714 patients were included from the Medical Information Mart for Intensive Care IV. SHR was associated with an increased risk of AKI (OR_adjusted 1.29 95%CI 1.05-1.59). Among AKI patients, SHR was associated with increased risks of AKD (OR_adjusted 1.94 95%CI 1.57-2.39), ICU mortality (OR_adjusted 2.31 95%CI 1.60-3.32), 28-day mortality (HR_adjusted 1.39 95%CI 1.29-1.50), 90-day mortality (HR_adjusted 1.37 95%CI 1.26-1.48), and 1-year mortality (HR_adjusted 1.37 95%CI 1.27-1.47). RCS analysis revealed a linear relationship with AKI, a J-shaped relationship with AKD, and a U-shaped relationship with mortality. Subgroup analysis confirmed the consistency of relationship between SHR and AKI. SHR demonstrates significant associations with AKI incidence, and correlates with AKD progression/mortality in critically ill adult ICU patients, suggesting its potential as a risk stratification and prognostic tool for AKI management, though further prospective validation is required.

Keywords: Stress hyperglycemia ratio; acute kidney disease; acute kidney injury; intensive care unit; mortality.

Figure 1.

Case inclusion flowchart. A visual representation of 3714 ICU stays selected from a total of 94458 ICU stays in MIMIC-IV. Patients were divided into three groups based on SHR tertiles: tertile 1: <1.0, tertile 2: 1.0–1.1, and tertile 3: >1.1. MIMIC, Medical Information Mart for Intensive Care; AKI, acute kidney injury; ICU, intensive care unit; ABG, admission blood glucose; HbA1c, glycosylated hemoglobin A1c.

Figure 2.

Restricted cubic spline analysis. The reverse linear association between the SHR and AKI was observed in A. A J-shaped association between the SHR and AKD was observed in B. A U-shaped association between the SHR and mortality was observed in D–F. A Restricted cubic spline analysis for AKI in the first 48 h after ICU admission; B restricted cubic spline analysis for AKD; C restricted cubic spline analysis for ICU mortality; D restricted cubic spline analysis for 28-day mortality; E restricted cubic spline analysis for 90-day mortality; F restricted cubic spline analysis for 1-year mortality. CI, confidence interval; OR, odds ratio; SHR, stress-hyperglycemia ratio; HR, hazard ratio; AKI, acute kidney injury; AKD, acute kidney disease; ICU, intensive care unit.