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Stress hyperglycemia is associated with poor prognosis in critically ill patients with cardiogenic shock

Jing Tian1, Tao Zhou1, Zijuan Liu1

  • 1Department of Critical Care Medicine, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wux, Jiangsu, China.

Frontiers in Endocrinology
|September 20, 2024
PubMed

Insights

Stress hyperglycemia, indicated by the Stress Hyperglycemia Ratio (SHR), is linked to worse outcomes in intensive care unit (ICU) patients with cardiogenic shock (CS). Higher SHR levels correlate with increased ICU mortality in these critically ill patients.

Area of Science:

  • Critical Care Medicine
  • Cardiology
  • Endocrinology

Background:

  • Stress hyperglycemia is prevalent in intensive care unit (ICU) patients and associated with poor prognosis.
  • The prognostic significance of stress hyperglycemia in critically ill patients with cardiogenic shock (CS) remains unclear.
  • This study aimed to clarify the relationship between stress hyperglycemia and outcomes in CS patients.

Purpose of the Study:

  • To investigate the prognostic value of stress hyperglycemia in critically ill patients experiencing cardiogenic shock.
  • To determine the association between the Stress Hyperglycemia Ratio (SHR) and mortality in this patient population.

Main Methods:

  • A retrospective analysis of 393 critically ill patients with CS from the MIMIC IV database.
  • Patients were stratified into four groups based on quartiles of the Stress Hyperglycemia Ratio (SHR).
  • Restricted cubic spline analysis and Cox proportional hazards models were used to assess the correlation between SHR and ICU/hospitalization mortality.

Main Results:

  • No significant differences in baseline demographics or vital signs were observed across SHR quartiles.
  • Elevated levels of lactate, WBC, AST, glucose, and HbA1c, along with increased mechanical ventilation use and longer ICU/hospital stays, were noted with higher SHR quartiles.
  • After adjusting for confounders, SHR demonstrated a significant U-shaped association with ICU mortality.

Conclusions:

  • Stress hyperglycemia, as assessed by SHR, is significantly associated with ICU mortality in critically ill patients with cardiogenic shock.
  • The findings highlight the prognostic importance of monitoring stress hyperglycemia in CS patients.
Abstract

Keywords:
MIMIC-IV databasecardiogenic shock (CS)critical caremortalitystress hyperglycemia ratio (SHR)

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