Scholarlink

Aims <p>This study aimed to investigate the association between the Stress Hyperglycemia Ratio (SHR) and mortality risk in critically ill patients with cardiometabolic multimorbidity (CMM), and to explore the potential mediating roles of white blood cell count (WBC), albumin, and creatinine.</p> Methods <p>We conducted a multicenter retrospective cohort study using data from the MIMIC-IV database (<i>n</i> = 1,214) for derivation and the NWICU database (<i>n</i> = 686) for external validation. The relationship between SHR and all-cause/28-day mortality was analyzed using multivariate logistic regression, restricted cubic splines, and machine learning models. Mediation analysis was performed to assess the roles of WBC, albumin, and creatinine.</p> Results <p>A nonlinear relationship with threshold effects was observed between SHR and mortality. In the fully adjusted model, the highest SHR tertile (Q3) was independently associated with increased risks of all-cause mortality (OR = 1.58, 95% CI: 1.13–2.20) and 28-day mortality (OR = 1.98, 95% CI: 1.24–3.18). Random Forest and XGBoost models demonstrated the best predictive performance for 28-day mortality (AUC = 0.765). Calibration curves confirmed the reliability of the risk estimates. Mediation analysis indicated that WBC and creatinine may partially mediated the adverse effects of SHR, while albumin exerted a protective mediating effect.</p> Conclusions <p>SHR is a significant and independent predictor of mortality in critically ill patients with CMM, exhibiting a nonlinear association. WBC, creatinine, and albumin may partially mediate this relationship, offering insights for future mechanistic studies. However, these findings are specific to the ICU population and warrant further validation in other cohorts.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Stress hyperglycemia ratio and mortality risk in cardiometabolic multimorbidity: a multicenter retrospective study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年1月31日

查看全文
  • Jing Tian,
  • Xinyi Chang,
  • Yue Guo,
  • Jun Liu,
  • Dian Yu,
  • Xiaoyun Song,
  • Yi Han

摘要

Aims

This study aimed to investigate the association between the Stress Hyperglycemia Ratio (SHR) and mortality risk in critically ill patients with cardiometabolic multimorbidity (CMM), and to explore the potential mediating roles of white blood cell count (WBC), albumin, and creatinine.

Methods

We conducted a multicenter retrospective cohort study using data from the MIMIC-IV database (n = 1,214) for derivation and the NWICU database (n = 686) for external validation. The relationship between SHR and all-cause/28-day mortality was analyzed using multivariate logistic regression, restricted cubic splines, and machine learning models. Mediation analysis was performed to assess the roles of WBC, albumin, and creatinine.

Results

A nonlinear relationship with threshold effects was observed between SHR and mortality. In the fully adjusted model, the highest SHR tertile (Q3) was independently associated with increased risks of all-cause mortality (OR = 1.58, 95% CI: 1.13–2.20) and 28-day mortality (OR = 1.98, 95% CI: 1.24–3.18). Random Forest and XGBoost models demonstrated the best predictive performance for 28-day mortality (AUC = 0.765). Calibration curves confirmed the reliability of the risk estimates. Mediation analysis indicated that WBC and creatinine may partially mediated the adverse effects of SHR, while albumin exerted a protective mediating effect.

Conclusions

SHR is a significant and independent predictor of mortality in critically ill patients with CMM, exhibiting a nonlinear association. WBC, creatinine, and albumin may partially mediate this relationship, offering insights for future mechanistic studies. However, these findings are specific to the ICU population and warrant further validation in other cohorts.