The Relationship Between Stress Hyperglycemia Ratio and Short-Term Mortality in Critically Ill Septic Patients: A Diabetes Status-Based Stratified Analysis - Scorecard - MDSpire

The Relationship Between Stress Hyperglycemia Ratio and Short-Term Mortality in Critically Ill Septic Patients: A Diabetes Status-Based Stratified Analysis

  • By

  • Heping Xu

  • Xue Lv

  • Yan Xia

  • Huan Niu

  • Jiangyan Li

  • Ping He

  • March 11, 2026

  • 0 min

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Clinical Scorecard: The Relationship Between Stress Hyperglycemia Ratio and Short-Term Mortality in Critically Ill Septic Patients: A Diabetes Status-Based Stratified Analysis

At a Glance

CategoryDetail
ConditionSepsis with acute organ dysfunction and stress hyperglycemia
Key MechanismsStress hyperglycemia reflects neuroendocrine activation, inflammation, and insulin resistance; SHR adjusts admission glucose by chronic glycemic status (HbA1c)
Target PopulationAdult critically ill patients diagnosed with sepsis in ICU settings
Care SettingIntensive Care Unit (ICU)

Key Highlights

  • Stress hyperglycemia ratio (SHR) is calculated as admission glucose divided by estimated average glucose from HbA1c, providing individualized glycemic assessment.
  • Higher SHR at ICU admission is independently associated with increased 28-day and 90-day all-cause mortality in septic patients.
  • The relationship between SHR and mortality is evaluated across diabetes subgroups using large-scale MIMIC-IV ICU data with rigorous confounding adjustment.

Guideline-Based Recommendations

Diagnosis

  • Diagnose sepsis using Sepsis-3 criteria with SOFA score ≥ 2.
  • Calculate SHR using formula: SHR = admission glucose (mg/dL) / (28.7 × HbA1c (%) − 46.7).
  • Identify septic shock by lactate > 2.0 mmol/L plus vasopressor requirement.

Management

  • Use SHR to stratify risk and guide early intervention in septic patients.
  • Consider chronic glycemic status when interpreting hyperglycemia in critical illness.

Monitoring & Follow-up

  • Monitor admission glucose and HbA1c to calculate SHR for risk assessment.
  • Track 28-day and 90-day mortality outcomes in relation to SHR levels.

Risks

  • High SHR indicates increased risk of short-term mortality in sepsis.
  • Interpret single glucose measurements cautiously without accounting for baseline glycemia.

Patient & Prescribing Data

Critically ill adult septic patients with available admission glucose and HbA1c data

SHR provides a more accurate risk stratification metric than absolute glucose alone, supporting tailored glycemic management strategies in sepsis.

Clinical Best Practices

  • Exclude patients with incomplete glucose or HbA1c data to ensure accurate SHR calculation.
  • Use multiple imputation methods to handle missing data when analyzing SHR and outcomes.
  • Apply standardized sepsis definitions and validated scoring systems (SOFA, SAPS II) for consistent patient assessment.
  • Consider diabetes status stratification when evaluating SHR-related mortality risk.

References

Original Source(s)

The Relationship Between Stress Hyperglycemia Ratio and Short-Term Mortality in Critically Ill Septic Patients: A Diabetes Status-Based Stratified Analysis

  • by Heping Xu, Xue Lv, Yan Xia, Huan Niu, Jiangyan Li, Ping He

  • March 11, 2026

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