Association between stress hyperglycemia ratio and prognosis of patients hospitalized with COVID-19: A meta-analysis

Stress hyperglycemia ratio (SHR), calculated by dividing admission glucose levels by estimated chronic glucose levels, has emerged as a novel marker of glycemic stress. However, its prognostic value in patients hospitalized with COVID-19 remains unclear. This meta-analysis investigates the association between SHR and adverse outcomes in this population.

A comprehensive literature search was conducted in PubMed, Embase, and Web of Science databases for relevant observational studies. The primary outcome was a composite of ICU admission, invasive mechanical ventilation (IMV), and all-cause in-hospital mortality. Secondary outcomes included the individual components of the primary outcome. A random effects model was used to pool the results by incorporating heterogeneity.

Seven studies involving 2,272 patients were included. Patients with a high SHR had a significantly higher risk of poor composite outcomes (risk ratio [RR]: 1.93, 95% confidence interval [CI]: 1.54-2.43; I² = 56%). Subgroup analyses according to study country, age, sex, diabetic status, and cutoff of SHR showed consistent results (P for subgroup difference all >0.05). Secondary analyses revealed increased risks of ICU admission (RR: 1.77), IMV (RR: 1.87), and in-hospital mortality (RR: 2.25) in patients with a high SHR at admission.

High SHR at admission is independently associated with poor prognosis in patients hospitalized with COVID-19. However, as admission glucose levels in most studies were not standardized for fasting status, SHR may be influenced by postprandial hyperglycemia, which should be considered when interpreting its prognostic value.