ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1526169
This article is part of the Research TopicNew Insights on Vascular and Metabolic Diabetic ComplicationsView all 12 articles
Association between the stress hyperglycemia ratio and all-cause mortality in patients with hemorrhagic stroke: A retrospective analysis based on MIMIC-IV database
Provisionally accepted
- West China Hospital, Sichuan University, Chengdu, China
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Background: Research on the associations between the stress hyperglycemia ratio (SHR) and adverse outcomes in patients with hemorrhagic stroke is limited. Therefore, we aimed to investigate the relationship between the SHR and all-cause mortality in patients with hemorrhagic stroke.Methods: Clinical data of patients with hemorrhagic stroke were extracted from the MIMIC-IV database. The patients were divided into four groups based on the SHR quartiles. Outcomes including 28-day, 90-day, and 365-day all-cause mortality were analyzed. Kaplan-Meier curves, Cox proportional hazard regression, and restricted cubic splines were used to investigate the relationships between the SHR and all-cause mortality. A machine learning prediction model integrating SHR was developed to assess its prognostic value for all-cause mortality.Results: The final analysis cohort consisted of 939 patients. Compared to the lowest SHR quartile, the highest quartile had significantly increased mortality risks at 28 days (HR=4.53, 95% CI: 2.75-7.46; p<0.001), 90 days (HR=3.29, 2.19-4.95; p<0.001), and 365 days (HR=2.25, 1.60-3.17; p<0.001). A significant upward trend in mortality risk was observed across ascending SHR quartiles (p-trend<0.001 for all timepoints). Restricted cubic spline analysis demonstrated nonlinear associations between SHR and all-cause mortality at 28 days and 90 days (p-nonlinear<0.05), while the overall trend remained significantly positive. The machine learning models identified SHR as a key predictor, with AUCs of 0.771 (28-day), 0.778 (90-day), and 0.778 (365-day).Conclusion: This study revealed threshold-dependent associations between the SHR and short- and long-term all-cause mortality in patients with hemorrhagic stroke. The SHR was a reliable predictor for adverse outcomes in patients with hemorrhagic stroke.
Keywords: Stress hyperglycemia ratio, Stroke, Boruta algorithm, Mortality, Retrospective study
Received: 11 Nov 2024; Accepted: 12 May 2025.
Copyright: © 2025 Zhu, Wen, Duan, Fan and Jiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yan Jiang, West China Hospital, Sichuan University, Chengdu, China
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