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Background <p>Stress hyperglycemia ratio (SHR) has emerged as a more accurate indicator of stress-related hyperglycemia than absolute glucose levels. However, its relationship with early neurological deterioration (END) after acute ischemic stroke (AIS) remains unclear.</p> Methods <p>We retrospectively analyzed 1,479 AIS patients admitted within 24&#xa0;h of symptom onset. END was defined as an increase of ≥ 2 points in the NIHSS total or motor score within 72&#xa0;h. SHR was calculated as the ratio of fasting plasma glucose to estimated average glucose derived from HbA1c and categorized into quartiles. Logistic regression, generalized additive models (GAM), two-piecewise logistic regression, and statistical mediation analyses were performed.</p> Results <p>Among 1,479 patients, 270 (18.3%) developed END. Higher SHR was independently associated with increased END risk (fully adjusted OR = 6.19, 95% CI: 2.68–14.28, <i>P</i> &lt; 0.0001), showing a clear dose-response relationship across quartiles (P for trend = 0.0015). GAM revealed a non-linear relationship, and two-piecewise regression identified a potential inflection point at SHR ≈ 1.06. Subgroup analysis showed a stronger association in non-diabetic patients (interaction <i>P</i> = 0.0033), with no significant interactions for other variables. Sensitivity analysis adjusting for C-reactive protein (CRP) and white blood cell (WBC) count remained robust after adjustment. Mediation analysis indicated that CRP and WBC were statistically associated with the SHR-END relationship, with mediation proportions of 12.89% and 8.03%, respectively.</p> Conclusions <p>Elevated SHR was associated with an increased risk of early neurological deterioration in patients with acute ischemic stroke, following a non-linear pattern without a defined threshold. The association was more pronounced in non-diabetic patients, suggesting heterogeneity across metabolic subgroups. These findings support the potential value of SHR for early risk stratification and warrant further prospective validation.</p>

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Association between stress hyperglycemia ratio and early neurological deterioration after acute ischemic stroke: a retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年1月21日

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  • Wei Yang,
  • Yiji Shen,
  • Yuehua Fei,
  • Tongcai Tan,
  • Yong Liu

摘要

Background

Stress hyperglycemia ratio (SHR) has emerged as a more accurate indicator of stress-related hyperglycemia than absolute glucose levels. However, its relationship with early neurological deterioration (END) after acute ischemic stroke (AIS) remains unclear.

Methods

We retrospectively analyzed 1,479 AIS patients admitted within 24 h of symptom onset. END was defined as an increase of ≥ 2 points in the NIHSS total or motor score within 72 h. SHR was calculated as the ratio of fasting plasma glucose to estimated average glucose derived from HbA1c and categorized into quartiles. Logistic regression, generalized additive models (GAM), two-piecewise logistic regression, and statistical mediation analyses were performed.

Results

Among 1,479 patients, 270 (18.3%) developed END. Higher SHR was independently associated with increased END risk (fully adjusted OR = 6.19, 95% CI: 2.68–14.28, P < 0.0001), showing a clear dose-response relationship across quartiles (P for trend = 0.0015). GAM revealed a non-linear relationship, and two-piecewise regression identified a potential inflection point at SHR ≈ 1.06. Subgroup analysis showed a stronger association in non-diabetic patients (interaction P = 0.0033), with no significant interactions for other variables. Sensitivity analysis adjusting for C-reactive protein (CRP) and white blood cell (WBC) count remained robust after adjustment. Mediation analysis indicated that CRP and WBC were statistically associated with the SHR-END relationship, with mediation proportions of 12.89% and 8.03%, respectively.

Conclusions

Elevated SHR was associated with an increased risk of early neurological deterioration in patients with acute ischemic stroke, following a non-linear pattern without a defined threshold. The association was more pronounced in non-diabetic patients, suggesting heterogeneity across metabolic subgroups. These findings support the potential value of SHR for early risk stratification and warrant further prospective validation.