U-shaped association of the stress hyperglycemia ratio for all-cause and cardiovascular mortality in patients with NAFLD: results from the NHANES database prospective cohort study
Abstract Objective Stress hyperglycemia ratio (SHR), an index reflecting relative hyperglycemia under stress conditions, has been linked to adverse outcomes in various clinical settings. However, its prognostic significance in individuals with nonalcoholic fatty liver disease (NAFLD) remains poorly...
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BMC
2025-07-01
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| Series: | BMC Gastroenterology |
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| Online Access: | https://doi.org/10.1186/s12876-025-04082-9 |
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| author | Yitian Dong Jiayuan Ye Hui Li Weiliang Kong Guoqing Qian Yilian Xie |
| author_facet | Yitian Dong Jiayuan Ye Hui Li Weiliang Kong Guoqing Qian Yilian Xie |
| author_sort | Yitian Dong |
| collection | DOAJ |
| description | Abstract Objective Stress hyperglycemia ratio (SHR), an index reflecting relative hyperglycemia under stress conditions, has been linked to adverse outcomes in various clinical settings. However, its prognostic significance in individuals with nonalcoholic fatty liver disease (NAFLD) remains poorly understood. This study aimed to examine the association between SHR and mortality risk in adults with NAFLD. Methods We analyzed 12,604 adults with NAFLD from the NHANES 1999–2018 database. Multivariable Cox proportional hazards models, restricted cubic spline (RCS) analysis, and Fine–Gray competing risk models were employed to evaluate associations between SHR and all-cause and cardiovascular mortality, Results During an overall mean follow-up time of 99.26 months, a U-shaped relationship was observed between SHR and all-cause mortality in adults aged 40–59 years and ≥ 60 years. Risk increased at both low and high SHR levels, with identified thresholds at 0.89 for middle-aged and 0.94 for older adults. No significant association was found with cardiovascular mortality. Findings were consistent across subgroups. Conclusion SHR showed a U-shaped association with all-cause mortality in middle-aged and older adults with NAFLD. Monitoring SHR may help identify high-risk individuals and guide clinical management. |
| format | Article |
| id | doaj-art-fa6f99977a3f4846adb308ef715e4e8b |
| institution | Kabale University |
| issn | 1471-230X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj-art-fa6f99977a3f4846adb308ef715e4e8b2025-08-20T04:01:35ZengBMCBMC Gastroenterology1471-230X2025-07-0125111510.1186/s12876-025-04082-9U-shaped association of the stress hyperglycemia ratio for all-cause and cardiovascular mortality in patients with NAFLD: results from the NHANES database prospective cohort studyYitian Dong0Jiayuan Ye1Hui Li2Weiliang Kong3Guoqing Qian4Yilian Xie5Health Science Center, Ningbo UniversityDepartment of Infectious Diseases, Shangyu People’s Hospital Of ShaoxingHealth Science Center, Ningbo UniversityDepartment of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Ningbo UniversityDepartment of Infectious Diseases, The First Affiliated Hospital of Ningbo UniversityDepartment of Infectious Diseases, The First Affiliated Hospital of Ningbo UniversityAbstract Objective Stress hyperglycemia ratio (SHR), an index reflecting relative hyperglycemia under stress conditions, has been linked to adverse outcomes in various clinical settings. However, its prognostic significance in individuals with nonalcoholic fatty liver disease (NAFLD) remains poorly understood. This study aimed to examine the association between SHR and mortality risk in adults with NAFLD. Methods We analyzed 12,604 adults with NAFLD from the NHANES 1999–2018 database. Multivariable Cox proportional hazards models, restricted cubic spline (RCS) analysis, and Fine–Gray competing risk models were employed to evaluate associations between SHR and all-cause and cardiovascular mortality, Results During an overall mean follow-up time of 99.26 months, a U-shaped relationship was observed between SHR and all-cause mortality in adults aged 40–59 years and ≥ 60 years. Risk increased at both low and high SHR levels, with identified thresholds at 0.89 for middle-aged and 0.94 for older adults. No significant association was found with cardiovascular mortality. Findings were consistent across subgroups. Conclusion SHR showed a U-shaped association with all-cause mortality in middle-aged and older adults with NAFLD. Monitoring SHR may help identify high-risk individuals and guide clinical management.https://doi.org/10.1186/s12876-025-04082-9NAFLDSHRNHANESAll-cause mortalityCardiovascular mortality |
| spellingShingle | Yitian Dong Jiayuan Ye Hui Li Weiliang Kong Guoqing Qian Yilian Xie U-shaped association of the stress hyperglycemia ratio for all-cause and cardiovascular mortality in patients with NAFLD: results from the NHANES database prospective cohort study BMC Gastroenterology NAFLD SHR NHANES All-cause mortality Cardiovascular mortality |
| title | U-shaped association of the stress hyperglycemia ratio for all-cause and cardiovascular mortality in patients with NAFLD: results from the NHANES database prospective cohort study |
| title_full | U-shaped association of the stress hyperglycemia ratio for all-cause and cardiovascular mortality in patients with NAFLD: results from the NHANES database prospective cohort study |
| title_fullStr | U-shaped association of the stress hyperglycemia ratio for all-cause and cardiovascular mortality in patients with NAFLD: results from the NHANES database prospective cohort study |
| title_full_unstemmed | U-shaped association of the stress hyperglycemia ratio for all-cause and cardiovascular mortality in patients with NAFLD: results from the NHANES database prospective cohort study |
| title_short | U-shaped association of the stress hyperglycemia ratio for all-cause and cardiovascular mortality in patients with NAFLD: results from the NHANES database prospective cohort study |
| title_sort | u shaped association of the stress hyperglycemia ratio for all cause and cardiovascular mortality in patients with nafld results from the nhanes database prospective cohort study |
| topic | NAFLD SHR NHANES All-cause mortality Cardiovascular mortality |
| url | https://doi.org/10.1186/s12876-025-04082-9 |
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