Association between stress hyperglycemia ratio (SHR) and long-term mortality in patients with ischemic stroke: a retrospective cohort study
Abstract Background The stress hyperglycemia ratio (SHR) at the time of admission has been linked to short-term adverse outcomes in patients suffering from ischemic stroke (IS). However, the connection between SHR and long-term mortality in cases of IS has yet to be investigated. This study aimed to...
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BMC
2025-04-01
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| Series: | Cardiovascular Diabetology |
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| Online Access: | https://doi.org/10.1186/s12933-025-02730-8 |
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| author | Man Huang Wan Wang Dong-mei Ren Yan-qing Chen Ying Li Yan Li Wu-lin Li Fei Wang |
| author_facet | Man Huang Wan Wang Dong-mei Ren Yan-qing Chen Ying Li Yan Li Wu-lin Li Fei Wang |
| author_sort | Man Huang |
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| description | Abstract Background The stress hyperglycemia ratio (SHR) at the time of admission has been linked to short-term adverse outcomes in patients suffering from ischemic stroke (IS). However, the connection between SHR and long-term mortality in cases of IS has yet to be investigated. This study aimed to elucidate the connection between SHR and long-term mortality in IS patients, while also investigating the impact of stratification status on this relationship. Methods Data regarding IS patients were extracted from our medical institution’s undisclosed internal stroke database, spanning from January 2016 to December 2023. Participants were classified into three groups according to the tertiles of continuous SHR. The primary outcome centered on all-cause mortality over a six-year period, whereas the secondary outcome focused on in-hospital all-cause mortality. Cox regression analysis and Kaplan-Meier curves were utilized to assess the connection between SHR and mortality rates. To further investigate the nature of this relationship, a restricted cubic spline (RCS) analysis was performed to determine its linearity, and an iterative algorithm was employed to pinpoint the inflection points. Variations among the strata were depicted in a subgroup forest plot. The prognostic ability of SHR concerning mortality risk was illustrated through receiver operating characteristic (ROC) curves. Results Among the 4330 participants, the mean age was 69.3 ± 13.4 years, with 2805 individuals (64.8%) identified as male. SHR was linked to a heightened risk of all-cause mortality at the six-year follow-up (HR 1.605, 95% CI 1.099–2.345) and during hospitalization (HR 3.698, 95% CI 1.950–7.014) (P < 0.05). The RCS analysis uncovered a “U-shaped” nonlinear relationship between SHR and six-year all-cause mortality. Subgroup analyses revealed that, among the non-diabetic cohort, patients devoid of atrial fibrillation, and those who had not undergone endovascular treatment, both low and high SHR significantly elevated the six-year mortality risk compared to moderate SHR. Conclusion This study revealed that SHR is correlated with a heightened risk of six-year and in-hospital all-cause mortality in IS patients. A U-shaped nonlinear association is observed between SHR and six-year all-cause mortality. Therefore, SHR could potentially act as a significant predictor for adverse long-term outcomes in IS patients, thereby facilitating clinical decision-making and risk evaluation. Graphical abstract |
| format | Article |
| id | doaj-art-73ecf44324cb4e20a08b7c192a060049 |
| institution | OA Journals |
| issn | 1475-2840 |
| language | English |
| publishDate | 2025-04-01 |
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| series | Cardiovascular Diabetology |
| spelling | doaj-art-73ecf44324cb4e20a08b7c192a0600492025-08-20T02:20:06ZengBMCCardiovascular Diabetology1475-28402025-04-0124111710.1186/s12933-025-02730-8Association between stress hyperglycemia ratio (SHR) and long-term mortality in patients with ischemic stroke: a retrospective cohort studyMan Huang0Wan Wang1Dong-mei Ren2Yan-qing Chen3Ying Li4Yan Li5Wu-lin Li6Fei Wang7Department of Nursing, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health SciencesDepartment of Neurology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health SciencesDepartment of Nursing, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health SciencesDepartment of Nursing, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health SciencesDepartment of Nursing, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health SciencesDepartment of Nursing, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health SciencesDepartment of Nursing, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health SciencesShanghai Key Laboratory of Molecular Imaging, Department of Emergency and Critical Care Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health SciencesAbstract Background The stress hyperglycemia ratio (SHR) at the time of admission has been linked to short-term adverse outcomes in patients suffering from ischemic stroke (IS). However, the connection between SHR and long-term mortality in cases of IS has yet to be investigated. This study aimed to elucidate the connection between SHR and long-term mortality in IS patients, while also investigating the impact of stratification status on this relationship. Methods Data regarding IS patients were extracted from our medical institution’s undisclosed internal stroke database, spanning from January 2016 to December 2023. Participants were classified into three groups according to the tertiles of continuous SHR. The primary outcome centered on all-cause mortality over a six-year period, whereas the secondary outcome focused on in-hospital all-cause mortality. Cox regression analysis and Kaplan-Meier curves were utilized to assess the connection between SHR and mortality rates. To further investigate the nature of this relationship, a restricted cubic spline (RCS) analysis was performed to determine its linearity, and an iterative algorithm was employed to pinpoint the inflection points. Variations among the strata were depicted in a subgroup forest plot. The prognostic ability of SHR concerning mortality risk was illustrated through receiver operating characteristic (ROC) curves. Results Among the 4330 participants, the mean age was 69.3 ± 13.4 years, with 2805 individuals (64.8%) identified as male. SHR was linked to a heightened risk of all-cause mortality at the six-year follow-up (HR 1.605, 95% CI 1.099–2.345) and during hospitalization (HR 3.698, 95% CI 1.950–7.014) (P < 0.05). The RCS analysis uncovered a “U-shaped” nonlinear relationship between SHR and six-year all-cause mortality. Subgroup analyses revealed that, among the non-diabetic cohort, patients devoid of atrial fibrillation, and those who had not undergone endovascular treatment, both low and high SHR significantly elevated the six-year mortality risk compared to moderate SHR. Conclusion This study revealed that SHR is correlated with a heightened risk of six-year and in-hospital all-cause mortality in IS patients. A U-shaped nonlinear association is observed between SHR and six-year all-cause mortality. Therefore, SHR could potentially act as a significant predictor for adverse long-term outcomes in IS patients, thereby facilitating clinical decision-making and risk evaluation. Graphical abstracthttps://doi.org/10.1186/s12933-025-02730-8Ischemic strokeStress hyperglycemia ratioLong-term mortalityPredictiveCohort study |
| spellingShingle | Man Huang Wan Wang Dong-mei Ren Yan-qing Chen Ying Li Yan Li Wu-lin Li Fei Wang Association between stress hyperglycemia ratio (SHR) and long-term mortality in patients with ischemic stroke: a retrospective cohort study Cardiovascular Diabetology Ischemic stroke Stress hyperglycemia ratio Long-term mortality Predictive Cohort study |
| title | Association between stress hyperglycemia ratio (SHR) and long-term mortality in patients with ischemic stroke: a retrospective cohort study |
| title_full | Association between stress hyperglycemia ratio (SHR) and long-term mortality in patients with ischemic stroke: a retrospective cohort study |
| title_fullStr | Association between stress hyperglycemia ratio (SHR) and long-term mortality in patients with ischemic stroke: a retrospective cohort study |
| title_full_unstemmed | Association between stress hyperglycemia ratio (SHR) and long-term mortality in patients with ischemic stroke: a retrospective cohort study |
| title_short | Association between stress hyperglycemia ratio (SHR) and long-term mortality in patients with ischemic stroke: a retrospective cohort study |
| title_sort | association between stress hyperglycemia ratio shr and long term mortality in patients with ischemic stroke a retrospective cohort study |
| topic | Ischemic stroke Stress hyperglycemia ratio Long-term mortality Predictive Cohort study |
| url | https://doi.org/10.1186/s12933-025-02730-8 |
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