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Key summary points Aim <p>This study aims to evaluate the association between stress hyperglycemia ratio and postoperative delirium and to assess the clinical utility of stress hyperglycemia ratio for postoperative delirium risk stratification in older patients undergoing non-cardiac surgery.</p> Findings <p>Higher stress hyperglycemia ratio was associated with greater postoperative delirium risk.</p> Message <p>Elevated preoperative stress hyperglycemia ratio is independently associated with postoperative delirium but adds limited predictive value to established risk tools.</p> Abstract Purpose <p>Postoperative delirium (POD) is a common and serious syndrome in older patients receiving surgery. The stress hyperglycemia ratio (SHR), derived from admission glucose and glycated hemoglobin (HbA1c), effectively quantifies acute-on-chronic glycemic dysregulation. However, the association between POD and SHR remains underexplored.</p> Methods <p>In this retrospective cohort study, we analyzed 3,241 adults aged ≥ 65&#xa0;years, selected from an initial pool of 57,597, who underwent non-cardiac, non-neurological surgery between 2014 and 2021 and had available fasting glucose and HbA1c data. POD occurring within 7&#xa0;days post-surgery was ascertained from electronic health records using Confusion Assessment Method (CAM) criteria. Associations between SHR and POD were robustly estimated using logistic regression, further supported by propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). Prespecified analyses included subgroup investigations and mediation assessments involving C-reactive protein (CRP) and white blood cell count (WBC). Predictive performance was evaluated through ROC curve analysis and reclassification metrics.</p> Results <p>POD incidence was 3.27% (106/3,241 patients). An exploratory, ROC-derived SHR cut-off was established at 0.882. Higher SHR was significantly associated with an increased risk of POD. These findings remained consistent after adjustment via PSM and IPTW. While associations were broadly consistent across various subgroups (age, BMI, coronary heart disease, renal insufficiency), a significant interaction was observed for midazolam use. Mediation analysis revealed a small, CRP-mediated pathway accounting for approximately 2.8% of the total effect. Incorporating categorical SHR resulted in only marginal improvements in the discrimination of the PIPRA model, whereas treating SHR as a continuous variable yielded negligible gains.</p> Conclusions <p>Preoperative SHR is independently linked to POD risk in older surgical populations, though it yields only marginal gains in predictive performance. As an accessible and inexpensive metric, SHR represents a complementary clinical parameter that may aid in refining preoperative risk assessment.</p> Graphical Abstract <p></p>

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Association between the preoperative stress hyperglycemia ratio and postoperative delirium in older adults undergoing non-cardiac surgery: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年7月3日

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  • Mengyao Qu,
  • Yanan He,
  • Lu Yu,
  • Yuxiang Song,
  • Huikai Yang,
  • Rui Wang,
  • Yixun Lu,
  • Miao Sun,
  • Baosheng Lv,
  • Yulong Ma,
  • Weidong Mi

摘要

Key summary points Aim

This study aims to evaluate the association between stress hyperglycemia ratio and postoperative delirium and to assess the clinical utility of stress hyperglycemia ratio for postoperative delirium risk stratification in older patients undergoing non-cardiac surgery.

Findings

Higher stress hyperglycemia ratio was associated with greater postoperative delirium risk.

Message

Elevated preoperative stress hyperglycemia ratio is independently associated with postoperative delirium but adds limited predictive value to established risk tools.

Abstract Purpose

Postoperative delirium (POD) is a common and serious syndrome in older patients receiving surgery. The stress hyperglycemia ratio (SHR), derived from admission glucose and glycated hemoglobin (HbA1c), effectively quantifies acute-on-chronic glycemic dysregulation. However, the association between POD and SHR remains underexplored.

Methods

In this retrospective cohort study, we analyzed 3,241 adults aged ≥ 65 years, selected from an initial pool of 57,597, who underwent non-cardiac, non-neurological surgery between 2014 and 2021 and had available fasting glucose and HbA1c data. POD occurring within 7 days post-surgery was ascertained from electronic health records using Confusion Assessment Method (CAM) criteria. Associations between SHR and POD were robustly estimated using logistic regression, further supported by propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). Prespecified analyses included subgroup investigations and mediation assessments involving C-reactive protein (CRP) and white blood cell count (WBC). Predictive performance was evaluated through ROC curve analysis and reclassification metrics.

Results

POD incidence was 3.27% (106/3,241 patients). An exploratory, ROC-derived SHR cut-off was established at 0.882. Higher SHR was significantly associated with an increased risk of POD. These findings remained consistent after adjustment via PSM and IPTW. While associations were broadly consistent across various subgroups (age, BMI, coronary heart disease, renal insufficiency), a significant interaction was observed for midazolam use. Mediation analysis revealed a small, CRP-mediated pathway accounting for approximately 2.8% of the total effect. Incorporating categorical SHR resulted in only marginal improvements in the discrimination of the PIPRA model, whereas treating SHR as a continuous variable yielded negligible gains.

Conclusions

Preoperative SHR is independently linked to POD risk in older surgical populations, though it yields only marginal gains in predictive performance. As an accessible and inexpensive metric, SHR represents a complementary clinical parameter that may aid in refining preoperative risk assessment.

Graphical Abstract