Association Between Stress Hyperglycemia Ratio and Death in Patients With Moderate to Severe Tricuspid Regurgitation

Tricuspid regurgitation (TR) progression correlates with worsened clinical outcomes. The stress hyperglycemia ratio (SHR), a biomarker of acute glycemic dysregulation under stress, has prognostic validity in multiple valvular diseases. This study aims to investigate the correlation between SHR and clinical prognosis in patients with moderate to severe TR.

Leveraging the RED-CARPET (Real-World Data of Cardiometabolic Protection) registry from the First Affiliated Hospital of Sun Yat-sen University, we analyzed 531 patients with moderate-to-severe TR categorized into quartiles (quartiles 1-4) by SHR. Primary end points were all-cause and cardiovascular disease (CVD) death. The association between SHR and death was assessed using a multivariable-adjusted Cox regression model. The incremental predictive value of incorporating SHR into the traditional risk model was also analyzed.

The cohort (mean age, 70.93 years) exhibited 38.9% all-cause deaths (207 events) and 20.0% CVD deaths (106 events) over 5.9-year median follow-up. After full adjustment, patients with SHR quartile 4 carried a 108% excess risk of all-cause death (hazard ratio [HR], 2.08 [95% CI, 1.34-3.23]) and more than twice the hazard of CVD death (HR, 2.40 [95% CI, 1.30-4.43]) versus quartile 1. The addition of SHR into the basic risk model for all-cause and CVD death improved the concordance statistics (both P<0.001), continuous-free net reclassification improvement value (P=0.040 for all-cause death and P=0.046 for CVD death), and integrated discrimination improvement value (P=0.040 for both all-cause and CVD death).

Elevated SHR is associated with an increased risk of all-cause death and CVD death in patients with moderate to severe TR.