Stress Hyperglycemia Ratio Predicts Short-Term Mortality in Critically Ill Septic Patients

Overview

This retrospective study of 15,876 ICU patients with sepsis found that a higher stress hyperglycemia ratio (SHR) at admission is independently associated with increased 28-day and 90-day all-cause mortality. The association persisted across diabetes status subgroups and demonstrated a nonlinear dose–response relationship.

Background

Sepsis is a life-threatening syndrome characterized by acute organ dysfunction due to a dysregulated host response to infection, with persistently high mortality despite advances in care. Stress hyperglycemia, common in critical illness, results from neuroendocrine activation and insulin resistance and is linked to adverse outcomes. The stress hyperglycemia ratio (SHR), which adjusts admission glucose by estimated average glucose from HbA1c, provides an individualized measure accounting for chronic glycemia. However, the relationship between SHR and mortality in sepsis remains inadequately characterized.

Data Highlights

Key Findings

• Higher SHR at ICU admission is independently associated with increased 28-day and 90-day mortality in septic patients.
• The relationship between SHR and mortality is nonlinear, as characterized by restricted cubic spline analysis.
• The association between SHR and mortality remains consistent across patients with and without diabetes.
• SHR provides a more individualized risk stratification metric than absolute glucose levels by accounting for chronic glycemic status.
• Robust statistical methods including multiple imputation and adjustment for confounders were employed to validate findings.

Clinical Implications

Measuring SHR at ICU admission can improve early risk stratification in septic patients by identifying those at higher risk of short-term mortality. This metric may guide clinicians in tailoring glycemic management strategies and prioritizing interventions. Accounting for chronic glycemic status avoids misinterpretation of absolute glucose values, particularly in diabetic patients.

Conclusion

The stress hyperglycemia ratio is a valuable prognostic biomarker in critically ill septic patients, independently predicting short-term mortality across diabetes subgroups. Incorporating SHR into clinical assessment may enhance sepsis management and outcome prediction.

References

1. Singer et al. 2016 -- The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
2. Beth Israel Deaconess Medical Center -- MIMIC-IV Database v3.1
3. Kilpatrick et al. 2017 -- Stress Hyperglycemia Ratio and Outcomes in Critical Illness