China: In patients with coronary artery disease (CAD), stress hyperglycemia ratio (SHR) is significantly associated with in-hospital mortality, a recent study in Cardiovascular Diabetology has found.
The findings indicate that SHR could effectively predict in-hospital mortality among CAD patients, particularly for patients with pre-diabetes Mellitus (DM) and DM.
In patients with acute coronary syndrome (ACS), there is a strong association between stress hyperglycemia and poor clinical outcomes. The SHR, recently, has been proposed to represent relative hyperglycemia. However, studies exploring the relationship between SHR and mortality in CAD are limited. Considering this, Wei Xu and the research team from China conducted the study to clarify the link between SHR and in-hospital mortality in CAD patients.

The study enrolled 19,929 CAD patients who were hospitalized at Beijing Hospital. Patients with an eGFR (estimated glomerular filtration rate) < 30 ml/min, missing blood glucose/HbA1c data, or cancer were excluded. Therefore, the final analysis included 8,196 patients. Based on tertiles of SHR, the patients were divided into three groups: T1 group with SHR < 0.725 (n = 2,732), T2 group with 0.725 ≤ SHR < 0.832 (n = 2,730), and T3 group with SHR ≥ 0.832 (n = 2,734). In-hospital mortality was the primary endpoint.
The study led to the following findings:
· The overall rate of in-hospital mortality was 0.91% (n = 74).
· SHR was notably associated with in-hospital mortality in CAD patients [odds ratio (OR) = 17.038] after adjusting for covariates, and a higher risk of in-hospital mortality (OR = 4.901) was seen in the T3 group compared with the T1 group.
·The T3 group had an increased mortality risk among patients with pre-diabetes Mellitus (OR = 9.670) and diabetes mellitus (OR = 5.023) after adjusting covariates in the subgroup analysis.
· Among patients with ACS, the relationship between SHR and in-hospital mortality and the chronic coronary syndrome was harmonious with the main result.
· SHR and in-hospital mortality showed a dose-response relationship, and the in-hospital mortality risk increased when the SHR index was above 1.20.
· SHR's area under the curve for in-hospital mortality prediction in CAD patients was 0.741.
"In patients with coronary heart disease, SHR is significantly associated with in-hospital mortality," researchers wrote in their conclusion. "Stress hyperglycemia ratio may be an effective predictor in CAD patients, particularly for those with pre-DM and DM."
Reference:
Xu, W., Song, Q., Wang, X. et al. Association of stress hyperglycemia ratio and in-hospital mortality in patients with coronary artery disease: insights from a large cohort study. Cardiovasc Diabetol 21, 217 (2022). https://doi.org/10.1186/s12933-022-01645-y