Stress Hyperglycemia Ratio may predict one-year mortality in CKD and critically ill patients, suggests study

Stress Hyperglycemia Ratio (SHR) was found to be a meaningful and valuable biomarker for predicting one-year mortality in ICU-admitted chronic kidney disease (CKD) patients and high-risk patients as per a recent study that was published in the journal BMC Nephrology.

Recent trends show an acute increase in chronic kidney diseases globally associated with increased cardiovascular events, morbidities, and increased mortality rates. Critically sick patients were also found to have CKD and had increased mortality compared to non-CKD. Literature showed that stress hyperglycemia (SHR) is a new biomarker correlated with adverse clinical outcomes in ICU and chronically sick individuals. Hence researchers hypothesized an association between SHR and CKD and investigated the relation between SHR and one-year all-cause mortality rate in ICU-admitted CKD patients.

By utilizing data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, Patients diagnosed with CKD and with data of admission blood glucose (ABG) and glycated hemoglobin (HbA1c) were included. The primary endpoint was the incidence of all-cause mortality within one year follow-up. Multivariate restricted cubic spline (RCS) regression analysis was employed to visualize the relationship between SHR and one-year mortality, using 5 knots.

Findings:

• About 1825 CKD patients were included in the study.
• The multivariate RCS analysis showed a “U-shaped” relationship between SHR and one-year mortality indicating that both high and low levels of SHR were associated with increased mortality risk.
• Based on these results the study population was categorized into three groups: Group 1 (SHR<0.70), Group 2 (0.70≤SHR≤0.95), and Group 3 (SHR>0.95).
• The one-year outcomes were better in group 2 compared to the other two groups (p=0.0031) suggesting that moderate SHR levels were associated with better outcomes.
• Subgroup analysis also showed persistent results of this survival benefit as stratified by age, sex, CKD stage, anemia, and various clinical conditions

Thus, the study concluded that SHR is a valuable tool for physicians to assess the one-year mortality rate in ICU-admitted CKD patients.

Take-home points:

• Stress hyperglycemia is an indicator of inflammatory and neuro-hormonal derangements during acute conditions and is a more reliable biomarker than admission glucose level and fasting blood glucose.
• A U-shaped correlation indicates that high and low values increase the risk of death
• It is a better biomarker tool for clinicians to monitor ICU-admitted CKD patients
• It helps to identify the high-risk individuals and improve the prognostic accuracy.
• SHR is a valuable tool to manage glucose levels in critically ill and CKD patients.

Further Reading: An S, Ye Z, Che W, et al. Predictive value of stress hyperglycemia ratio on one-year mortality in chronic kidney disease patients admitted to intensive care unit. BMC Nephrol. 2024;25(1):358. Published 2024 Oct 17. doi:10.1186/s12882-024-03823-4