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A higher stress hyperglycemia ratio is associated with higher all-cause 30-day and 1-year mortality in patients with sepsis-associated acute kidney injury.

An increased stress hyperglycemia ratio (SHR) in patients with sepsis-associated acute kidney injury (SA-AKI) is independently associated with increased all-cause 30-day and 1-year mortality, according to a study published in BMC Infectious Diseases.

“Compared with admission glycemia and HbA1c, SHR demonstrated a stronger ability to predict all-cause mortality,” researchers wrote. “These findings suggest that SHR is a valuable index for risk stratification in patients with SA-AKI.”

Previous studies investigating SHR have identified associations with all-cause mortality in patients with heart failure and myocardial infarction and with 28-day mortality in patients with sepsis. The study analyzed the link between SHR and all-cause mortality in 1161 patients with SA-AKI from the Beth Israel Deaconess Medical Center, Boston, Massachusetts, between 2008 and 2019.

Researchers calculated SHR (glycemia [mmol/L]) / (1.59 × HbA1c [%] – 2.59) and divided patients into four groups based on the SHR quartile ranges: Quartile 1 (0.26-0.90), Quartile 2 (0.91-1.08), Quartile 3 (1.09-1.30), and Quartile 4 (1.31-5.42).

SHR Correlated With 30-Day, 1-Year Mortality

The patients had a median age of 69 years; 42.7% were women, and 56% were White. One-fifth had chronic kidney disease, and 11.4% had diabetes. Among patients, the in-hospital mortality rate was 18.5%, the 30-day mortality rate was 22.1%, and the 1-year mortality rate was 35%.

Kaplan- Meier survival analysis showed that as SHR quartiles increased, survival probability gradually decreased.

“An increased SHR exhibited a strong correlation with 30-day mortality (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.18–1.90; P<0.001) and 1-year mortality (HR, 1.32; 95% CI, 1.06–1.65; P=0.014),” researchers wrote.

The relationship between SHR and 1-year mortality was nonlinear but not 30-day mortality. The study did not find SHR to be an independent indicator of in-hospital mortality.

“The independent relationship between SHR and both 1-year and 30-day mortality reveals the long-term impact of SHR on critically ill patients, whereas the severity of acute events and clinical management may more directly influence in-hospital mortality,” researchers wrote.

The results of post-hoc subgroup analysis were mostly consistent with the primary analysis after controlling for potential confounding factors.

“As an easily generalizable indicator, SHR is an effective tool for risk stratification in patients with SA-AKI,” researchers concluded.