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Association of stress hyperglycemia ratio and mortality in patients with sepsis: results from 13,199 patients

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Abstract

Background

The stress hyperglycemia ratio (SHR), adjusted for average glycemic status, is suggested for assessing actual blood glucose levels. Its link with adverse outcomes is known in certain populations, yet its impact on sepsis patients’ prognosis is unclear. This study explores the association between SHR and mortality in sepsis.

Methods

We included 13,199 sepsis patients in this study and categorized SHR into distinct groups. Additionally, we utilized restricted cubic spline analysis to evaluate the correlation between SHR as a continuous variable and mortality. The primary outcome was 1-year all-cause mortality. Logistic regression and Cox proportional hazards models were employed to assess the associations between the SHR and both in-hospital mortality and 1-year mortality, respectively.

Results

Among the study participants, 4,690 (35.5%) patients died during the 1-year follow-up. After adjusting for confounding variables, we identified a U-shaped correlation between SHR and 1-year mortality. Using an SHR of 0.99 as the reference point, the hazard ratio for predicted 1-year mortality increased by 1.17 (95% CI 1.08 to 1.27) per standard deviation above 0.99, whereas each standard deviation increase predicted the hazard ratio of 0.52 (95% CI 0.39 to 0.69) below 0.99. Furthermore, we found that SHR could enhance the predictive performance of conventional severity scores.

Conclusion

There exists a U shaped association between SHR and mortality in sepsis patients, where both low and high SHR values are associated with an increased risk of poor outcomes.

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Data availability

The datasets used during the current study are available from the corresponding author upon reasonable request.

References

  1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:801–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546–54.

    Article  PubMed  Google Scholar 

  3. Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of Global Incidence and Mortality of Hospital-treated. Sepsis Current Estimates and Limitations. Am J Respir Crit Care Med. 2016;193:259–72.

    Article  CAS  PubMed  Google Scholar 

  4. Xie J, Wang H, Kang Y, Zhou L, Liu Z, Qin B, et al. The Epidemiology of Sepsis in Chinese ICUs: A National Cross-Sectional Survey. Crit Care Med. 2020;48:e209–18.

    Article  PubMed  Google Scholar 

  5. Chiu C, Legrand M. Epidemiology of sepsis and septic shock. Curr Opin Anaesthesiol. 2021;34:71–6.

    Article  PubMed  Google Scholar 

  6. Adhikari NK, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet. 2010;376:1339–46.

    Article  PubMed  PubMed Central  Google Scholar 

  7. van Vught LA, Klein Klouwenberg PM, Spitoni C, Scicluna BP, Wiewel MA, Horn J, et al. Incidence, Risk Factors, and Attributable Mortality of Secondary Infections in the Intensive Care Unit After Admission for Sepsis. JAMA. 2016;315:1469–79.

    Article  PubMed  Google Scholar 

  8. Martin-Loeches I, Guia MC, Vallecoccia MS, Suarez D, Ibarz M, Irazabal M, et al. Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study. Ann Intensive Care. 2019;9:26.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Pandolfi F, Brun-Buisson C, Guillemot D, Watier L. One-year hospital readmission for recurrent sepsis: associated risk factors and impact on 1-year mortality-a French nationwide study. Crit Care. 2022;26:371.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Marik PE, Bellomo R. Stress hyperglycemia: an essential survival response! Crit Care. 2013;17:305.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Zohar Y, Zilberman Itskovich S, Koren S, Zaidenstein R, Marchaim D, Koren R. The association of diabetes and hyperglycemia with sepsis outcomes: a population-based cohort analysis. Intern Emerg Med. 2021;16:719–28.

    Article  PubMed  Google Scholar 

  12. Lu Z, Tao G, Sun X, Zhang Y, Jiang M, Liu Y, et al. Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU Hospitalization. Front Public Health. 2022;10: 857368.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Roberts GW, Quinn SJ, Valentine N, Alhawassi T, O’Dea H, Stranks SN, et al. Relative Hyperglycemia, a Marker of Critical Illness: Introducing the Stress Hyperglycemia Ratio. J Clin Endocrinol Metab. 2015;100:4490–7.

    Article  CAS  PubMed  Google Scholar 

  14. Xu W, Song Q, Wang X, Zhao Z, Meng X, Xia C, 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. 2022;21:217.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Cui K, Fu R, Yang J, Xu H, Yin D, Song W, et al. Stress hyperglycemia ratio and long-term mortality after acute myocardial infarction in patients with and without diabetes: A prospective, nationwide, and multicentre registry. Diabetes Metab Res Rev. 2022;38: e3562.

    Article  CAS  PubMed  Google Scholar 

  16. Li L, Ding L, Zheng L, Wu L, Hu Z, Liu L, et al. U-shaped association between stress hyperglycemia ratio and risk of all-cause mortality in cardiac ICU. Diabetes Metab Syndr. 2024;18: 102932.

    Article  CAS  PubMed  Google Scholar 

  17. Li L, Zhao M, Zhang Z, Zhou L, Zhang Z, Xiong Y, et al. Prognostic significance of the stress hyperglycemia ratio in critically ill patients. Cardiovasc Diabetol. 2023;22:275.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. BMJ. 2016;353: i1585.

    Article  PubMed  Google Scholar 

  19. Marik PE, Raghavan M. Stress-hyperglycemia, insulin and immunomodulation in sepsis. Intensive Care Med. 2004;30:748–56.

    Article  PubMed  Google Scholar 

  20. Tiruvoipati R, Chiezey B, Lewis D, Ong K, Villanueva E, Haji K, et al. Stress hyperglycemia may not be harmful in critically ill patients with sepsis. J Crit Care. 2012;27:153–8.

    Article  CAS  PubMed  Google Scholar 

  21. Leonidou L, Michalaki M, Leonardou A, Polyzogopoulou E, Fouka K, Gerolymos M, et al. Stress-induced hyperglycemia in patients with severe sepsis: a compromising factor for survival. Am J Med Sci. 2008;336:467–71.

    Article  PubMed  Google Scholar 

  22. Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, et al. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:775–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Zhang Z. Multiple imputation with multivariate imputation by chained equation (MICE) package. Ann Transl Med. 2016;4:30.

    PubMed  PubMed Central  Google Scholar 

  24. Zhou Q, Yang J, Wang W, Shao C, Hua X, Tang YD. The impact of the stress hyperglycemia ratio on mortality and rehospitalization rate in patients with acute decompensated heart failure and diabetes. Cardiovasc Diabetol. 2023;22:189.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Wei QC, Chen YW, Gao QY, Ren KD, Liu YB, He F, et al. Association of stress hyperglycemia with clinical outcomes in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention: a cohort study. Cardiovasc Diabetol. 2023;22:85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Fabbri A, Marchesini G, Benazzi B, Morelli A, Montesi D, Bini C, et al. Stress Hyperglycemia and Mortality in Subjects With Diabetes and Sepsis. Crit Care Explor. 2020;2: e0152.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Yang J, Zheng Y, Li C, Gao J, Meng X, Zhang K, et al. The Impact of the Stress Hyperglycemia Ratio on Short-term and Long-term Poor Prognosis in Patients With Acute Coronary Syndrome: Insight From a Large Cohort Study in Asia. Diabetes Care. 2022;45:947–56.

    Article  CAS  PubMed  Google Scholar 

  28. McNamara JJ, Mills D, Aaby GV. Effect of hypertonic glucose on hemorrhagic shock in rabbits. Ann Thorac Surg. 1970;9:116–21.

    Article  CAS  PubMed  Google Scholar 

  29. Losser MR, Damoisel C, Payen D. Bench-to-bedside review: Glucose and stress conditions in the intensive care unit. Crit Care. 2010;14:231.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Malfitano C, Alba Loureiro TC, Rodrigues B, Sirvente R, Salemi VM, Rabechi NB, et al. Hyperglycaemia protects the heart after myocardial infarction: aspects of programmed cell survival and cell death. Eur J Heart Fail. 2010;12:659–67.

    Article  CAS  PubMed  Google Scholar 

  31. Bahadoran Z, Mirmiran P, Ghasemi A. Role of Nitric Oxide in Insulin Secretion and Glucose Metabolism. Trends Endocrinol Metab. 2020;31:118–30.

    Article  CAS  PubMed  Google Scholar 

  32. Ling PR, Smith RJ, Bistrian BR. Hyperglycemia enhances the cytokine production and oxidative responses to a low but not high dose of endotoxin in rats. Crit Care Med. 2005;33:1084–9.

    Article  CAS  PubMed  Google Scholar 

  33. Stentz FB, Umpierrez GE, Cuervo R, Kitabchi AE. Proinflammatory cytokines, markers of cardiovascular risks, oxidative stress, and lipid peroxidation in patients with hyperglycemic crises. Diabetes. 2004;53:2079–86.

    Article  CAS  PubMed  Google Scholar 

  34. Xu W, Zhao T, Xiao H. The Implication of Oxidative Stress and AMPK-Nrf2 Antioxidative Signaling in Pneumonia Pathogenesis. Front Endocrinol (Lausanne). 2020;11:400.

    Article  PubMed  Google Scholar 

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Acknowledgements

None.

Funding

This study was supported by the Medical and Health Technology Innovation Project of the Chinese Academy of Medical Sciences (2021-CXGC09-1).

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Authors and Affiliations

Authors

Contributions

This study was designed by LL and LKZ. XP, ZXZ, LKZ, YLX, ZHZ, and ZH were responsible for data collation and statistical analysis. LL wrote the first draft. YY reviewed and checked the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yan Yao.

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The authors declare no competing interests.

Conflict of interests

The authors declare that they have no competing interests.

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Li, L., Zhou, L., Peng, X. et al. Association of stress hyperglycemia ratio and mortality in patients with sepsis: results from 13,199 patients. Infection (2024). https://doi.org/10.1007/s15010-024-02264-3

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