Mode
Text Size
Log in / Sign up

Higher HbA1c-adjusted stress hyperglycemia ratio correlates with increased short-term mortality in severe respiratory diseasesHigher Stress Hyperglycemia Linked to Mortality in Respiratory Patients

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway
Note that higher HbA1c-adjusted stress hyperglycemia ratio is associated with increased short-term mortality in severe respiratory disease.

This meta-analysis evaluated the association between the HbA1c-adjusted stress hyperglycemia ratio (SHR) and short-term mortality in critically ill patients with severe respiratory diseases. The study synthesized data to determine if SHR serves as a predictor for mortality in intensive care settings.

HR-based results indicated a significant association between higher SHR and increased short-term mortality risk (HR = 1.87; 95% CI: 1.71-2.05, P = 0.001). Specifically, a 0.1-unit increase in SHR was associated with an approximately 5% increase in short-term mortality risk (HR = 1.05; 95% CI: 1.02-1.08, P = 0.023). Conversely, OR-based findings showed higher mortality in the highest SHR category compared to the reference, but these results did not reach statistical significance (OR = 2.72; 95% CI: 0.74-9.93, P = 0.091).

The authors noted several limitations, including substantial heterogeneity in OR-based findings (I2 = 86.4%) and imprecise exploratory analyses for low and high SHR. The number of included studies was limited, resulting in wide confidence intervals for some metrics. While HR-based evidence suggests a positive linear dose-response relationship, the authors noted that evidence for non-linear patterns, such as U-shaped or J-shaped curves, is currently insufficient to confirm such a trend.

Researchers analyzed data from patients with severe respiratory diseases in intensive care units. They looked at the relationship between a specific measure called the HbA1c-adjusted stress hyperglycemia ratio (SHR) and the risk of short-term mortality.

The analysis found a significant link between higher SHR levels and an increased risk of death. Specifically, for every 0.1 unit increase in the SHR, the risk of short-term mortality rose by about 5 percent. This suggests a steady increase in risk as the ratio goes up.

It is important to note that this study shows a link, not a direct cause. Some parts of the data were less consistent because of a small number of studies and wide confidence intervals. Because the evidence for complex patterns is not yet clear, these findings are currently used to identify a risk factor rather than to change immediate treatment plans.

What this means for you:
Higher stress hyperglycemia levels are linked to increased mortality risk in patients with severe respiratory diseases.

Common questions

What is the risk for patients with high stress hyperglycemia?

The study found that a higher stress hyperglycemia ratio (SHR) is associated with an increased risk of short-term mortality in patients with severe respiratory diseases. Specifically, for every 0.1-unit increase in the SHR, there was approximately a 5% increase in the risk of death.

Is this finding certain for all patients?

The evidence shows a link, but it is not a definitive proof of cause. Some data points were less precise due to a limited number of studies and wide confidence intervals. Because of these limitations, the findings are currently considered a link rather than a confirmed clinical rule.

How consistent was the data regarding mortality risk?

The results based on hazard ratios (HR) were more consistent than those based on odds ratios (OR). While the HR-based data showed a clear link between higher SHR and mortality, the OR-based data did not reach statistical significance and showed more variation.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
ObjectiveTo systematically evaluate the association between the HbA1c-adjusted stress hyperglycemia ratio (SHR) and short-term mortality in patients with severe respiratory diseases and characterize its linear and nonlinear dose-response relationships.MethodsPubMed, Embase, China National Knowledge Infrastructure, Wanfang, VIP, and the Chinese Biomedical Literature Database were searched for observational studies evaluating SHR and short-term mortality, including in-hospital, intensive care unit (ICU), 28-day, or 30-day mortality. Odds ratios (ORs) and hazard ratios (HRs) were pooled separately using random-effects models. Sensitivity analyses, linear dose-response analyses, restricted cubic spline analyses, and exploratory analyses of low and high SHR were performed.ResultsEleven studies were included. Four studies contributed to the OR-based primary meta-analysis. Short-term mortality tended to be higher in the highest SHR category than in the study-specific reference category, but the association was not statistically significant (OR = 2.72, 95% CI: 0.74–9.93, P = 0.091; I2 = 86.4%). Three studies contributed to the HR-based primary meta-analysis, which showed a significant association between higher SHR and increased short-term mortality risk (HR = 1.87, 95% CI: 1.71–2.05, P = 0.001; I2 = 0%). In HR studies, each 0.1-unit increase in SHR was associated with an approximately 5% increase in short-term mortality risk (HR = 1.05, 95% CI: 1.02–1.08, P = 0.023). OR studies showed a similar direction of association but did not reach statistical significance. Restricted cubic spline analyses found no clear evidence of nonlinearity. Exploratory analyses suggested higher risks at both low and high SHR levels, but the estimates were imprecise.ConclusionsCurrent evidence suggests that higher SHR is associated with increased short-term mortality risk in patients with severe respiratory diseases. HR-based evidence was more consistent and supported a positive linear dose-response relationship. OR-based findings pointed in the same direction but showed substantial heterogeneity and did not reach statistical significance. The available evidence is insufficient to confirm a clear nonlinear pattern. Given the limited number of studies and wide confidence intervals, the apparent increase in risk at both low and high SHR levels should be interpreted as exploratory and does not yet support a stable U-shaped or J-shaped dose-response pattern.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261418259, PROSPERO CRD420261418259.
Free Newsletter

Clinical research that matters. Delivered to your inbox.

Join thousands of clinicians and researchers. No spam, unsubscribe anytime.