ArticleCardiovascular diabetology2023
The impact of the stress hyperglycemia ratio on mortality and rehospitalization rate in patients with acute decompensated heart failure and diabetes.
Article in Cardiovascular diabetology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 4 of them syntheses that pooled it.
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61 citing papers in PubMed, 4 syntheses or guidelines pooled it, 76 citations in OpenAlex.
- Predictive performance of stress hyperglycemia ratio for poor prognosis in critically ill patients: a systematic review and dose-response meta-analysis.European journal of medical research · 2025Pooled it
- Relationship between stress hyperglycaemic ratio (SHR) and critical illness: a systematic review.Cardiovascular diabetology · 2025Pooled it
- The association between the stress hyperglycaemia ratio and mortality in cardiovascular disease: a meta-analysis and systematic review.Cardiovascular diabetology · 2024Pooled it
- Stress hyperglycemia ratio and the clinical outcome of patients with heart failure: a meta-analysis.Frontiers in endocrinology · 2024Pooled it
- Glycemic phenotype, age at diabetes diagnosis, and risk of cardiorenal syndrome type 1 in patients hospitalized with acute heart failure.International journal of cardiology. Heart & vasculature · 2026Article
- Combined assessment of triglyceride-glucose index and stress hyperglycemia ratio to predict all-cause mortality in critically ill patients with intracerebral hemorrhage.BMC neurology · 2026Article
- Association between stress hyperglycemia ratio and cognitive function in older patients with diabetes or prediabetes: a cross-sectional study from the NHANES.Endocrine journal · 2026Article
- Stress Hyperglycemia Ratio and the Risk of Sepsis in Patients With Heart Failure: Retrospective Cohort Study From Medical Information Mart for Intensive Care-IV.JMIR medical informatics · 2026Article
- Association of stress hyperglycemia ratio with the incidence of delirium in critically ill patients: a retrospective cohort study with exploratory machine-learning analyses.BMC neurology · 2026Article
- Acute-to-chronic glycemic ratio: a promising biomarker for prognosis of diabetic foot ulcers in a multi-center cohort study.Diabetology & metabolic syndrome · 2026Article
- Elevated cardiometabolic index is associated with an increased risk of cardiovascular and all-cause mortality in patients undergoing dialysis: a retrospective cohort study.BMC nephrology · 2026Article
- Association between stress hyperglycemia ratio and mortality of traumatic brain injury patients based on MIMIC-IV and eICU databases.BMC neurology · 2026Article
- Stress Hyperglycemia Ratio as a Predictor of All-Cause and Cardiovascular Mortality in the General Population: Insights From NHANES 2001-2018.International journal of endocrinology · 2026Article
- Article
- Stress Hyperglycemia Ratio Outperforms Admission Glucose in Predicting Coronary Slow Flow in Patients with Type 2 Diabetes Mellitus.International journal of general medicine · 2026Article
- Sex based disparities in glycemic control and hospitalization outcomes of medical patients with diabetes mellitus-a historical cohort study.Internal and emergency medicine · 2026Article
- Stress hyperglycemia ratio and long-term prognosis in patients with acute myocardial infarction undergoing percutaneous coronary intervention: evidence for an J-shaped association.Journal of geriatric cardiology : JGC · 2025Article
- Association between stress hyperglycemia ratio and all-cause mortality in critically ill patients with mitral valve disease.Scientific reports · 2025Article
- Observational
- Prognostic value of stress hyperglycemia ratio in patients with different plaque types with acute myocardial infarction.European journal of medical research · 2025Article
1 more citing papers are in PubMed but not listed here.
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6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe relationship between stress hyperglycemia and long-term prognosis in acute decompensated heart failure (ADHF) patients is unknown. This study investigated the associations of stress hyperglycemia with mortality and rehospitalization rates among ADHF patients with diabetes.
methodsWe consecutively enrolled 1904 ADHF patients. Among them, 780 were with diabetes. Stress hyperglycemia was estimated using the stress hyperglycemia ratio (SHR), which was calculated by the following formula: SHR = admission blood glucose/[(28.7 × HbA1c%) - 46.7]. All diabetic ADHF subjects were divided into quintiles according to the SHR. The primary endpoint was all-cause death at the 3-year follow-up. The secondary endpoints were cardiovascular (CV) death and heart failure (HF) rehospitalization at the 3-year follow-up. A Cox proportional hazards model and restricted cubic spline analysis were used to elucidate the relationship between the SHR and the endpoints in diabetic ADHF patients. Further analyses were performed to examine the relationships between SHR and the outcomes in heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).
resultsA total of 169 all-cause deaths were recorded during a median follow-up of 3.24 years. Restricted cubic spline analysis suggested a U-shaped association between the SHR and the mortality and rehospitalization rates. Kaplan-Meier survival analysis showed the lowest mortality in the 2nd quintile (P = 0.0028). Patients categorized in the highest range (5th quintile) of SHR, compared to those in the 2nd quintile, exhibited the greatest susceptibility to all-cause death (with a hazard ratio [HR] of 2.76 and a 95% confidence interval [CI] of 1.63-4.68), CV death (HR 2.81 [95% CI 1.66-4.75]) and the highest rate of HF rehospitalization (HR 1.54 [95% CI 1.03-2.32]). Similarly, patients in the lowest range (1st quintile) of SHR also exhibited significantly increased risks of all-cause death (HR 2.33, 95% CI 1.35-4.02) and CV death (HR 2.32, 95% CI 1.35-4.00). Further analyses indicated that the U-shape association between the SHR and mortality remained significant in both HFpEF and HFrEF patients.
conclusionBoth elevated and reduced SHRs indicate an unfavorable long-term prognosis in patients with ADHF and diabetes.
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