Stress hyperglycaemia ratio: A prognostic marker for mortality in cardiovascular disease

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Created On: 27/02/2025

The stress hyperglycaemia ratio (SHR) has emerged as a superior predictor of all-cause mortality when compared to absolute glucose levels.

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Key take away

A raised stress hyperglycaemia ratio indicates a greater risk of all-cause mortality following myocardial infarction and ischemic stroke.

Background

The stress hyperglycaemia ratio (SHR) has emerged as a superior predictor of all-cause mortality when compared to absolute glucose levels. This systematic review and meta-analysis sought to consolidate evidence linking SHR to mortality risk across 3 critical cardiovascular events.

Method

A thorough search of Web of Science, Cochrane CENTRAL, Embase, and Medline databases identified studies examining SHR in patients hospitalized for acute myocardial infarction, ischemic stroke, or acute heart failure. Eligible studies reported odds or hazard ratios for all-cause mortality linked to SHR. A random-effects model was employed for analysis, alongside subgroup evaluations by diabetes status and short- versus long-term mortality. The Newcastle-Ottawa Quality Assessment Scale was employed to determine bias risk.

Result

Overall, 32 studies met the inclusion criteria, with 26 studies contributing 31 estimates for meta-analysis (n = 80,010). In total, 6 additional studies were incorporated. Patients in the highest SHR category exhibited a markedly elevated risk of all-cause mortality, both short- and long-term, when compared to those with lower SHR (risk ratio [RR] = 1.67). The strongest associations were observed in myocardial infarction (RR = 1.75) and ischemic stroke cohorts (RR = 1.78).

The relationship was robust across both diabetes (RR = 1.49) and non-diabetes groups (RR = 1.85), with no vital subgroup difference. Mortality risks were evident in studies reporting it as a single outcome (RR = 1.51) and as part of composite outcomes (RR = 2.02). Elevated SHR was linked with heightened mortality risk at 90 days (RR = 1.84), 1 year (RR = 1.69), and beyond 1 year (RR = 1.58).

Conclusion

This analysis underscores SHR as a potent predictor of all-cause mortality after myocardial infarction and ischemic stroke, irrespective of diabetes status. The findings highlight an urgent need for clinical trials targeting SHR as a therapeutic parameter, potentially revolutionizing glucose management strategies in acute cardiovascular care. Establishing SHR reference values and investigating the role of relative hypoglycaemia are critical next steps.