Stress Hyperglycemia Ratio Predicts In-Hospital Mortality in AKI Patients: Study

A new study published in the journal of Clinical and Experimental Nephrology showed that the stress hyperglycemia ratio (SHR) is a standalone predictor of in-hospital mortality in patients diagnosed with acute kidney injury (AKI).

Stress hyperglycemia ratio is a novel indicator that shows acute increases in blood sugar compared to baseline levels. AKI is linked to high rates of in-hospital death, especially in critically ill individuals. Stress-induced high blood sugar levels can worsen oxidative stress, inflammation, endothelial dysfunction, and kidney damage, leading to negative results. Unlike actual blood sugar values, SHR considers long-term blood sugar levels, which could enhance the assessment of risks. Therefore, this research explored how the SHR relates to the likelihood of in-hospital death in AKI patients and to assess how well it can predict such outcomes.

This retrospective cohort investigation utilized the Medical Information Mart for Intensive Care (MIMIC-IV) and MIMIC-III repositories. The standardized hazard ratio (SHR) was characterized as the quotient of initial blood glucose level upon admission to the approximated mean glucose level. Restricted cubic spline regression was employed to scrutinize the non-linear correlation between SHR and mortality during hospitalization. 

In a cohort of 2180 patients, the in-hospital mortality rate was 18.8% (263 out of 1,398) in the MIMIC-IV database and 19.8% (155 out of 782) in the MIMIC-III database. The standardized hazard ratio (SHR) exhibited a U-shaped correlation with in-hospital mortality, indicating that SHR values greater than 1.19 or less than 0.50 significantly escalated the risk of death (P < 0.05).

This trend remained consistent across various subgroup analyses and sensitivity assessments. Analysis of the ROC curve revealed that the SHR provided superior predictive accuracy for in-hospital mortality among patients with AKI when compared to traditional severity and comorbidity scoring systems. The congruity of findings between both databases underscores the reliability of the results.

Overall, this study indicates that the SHR serves as a standalone indicator for predicting in-hospital mortality among patients with AKI. It identifies distinct risk categories by separating the very low SHR values from the moderately low values, revealing a two-way nonlinear risk trend. This differentiation aids in promptly identifying patients at high risk, enabling more effective risk assessment strategies.

Reference:

Zhang, J., Liu, J., Li, Y., Ma, W., Ma, Y., Li, S., & Yang, J. (2026). Stress hyperglycemia ratio as a predictor of in-hospital mortality in patients with acute kidney injury: a retrospective cohort study. Clinical and Experimental Nephrology. https://doi.org/10.1007/s10157-026-02953-3