Stress hyperglycemia ratio (SHR) has recently been recognized as a novel biomarker that accurately reflects acute hyperglycemia status and is associated with poor prognosis of heart failure. We evaluated the relationship between SHR and clinical outcomes in patients with severe aortic stenosis receiving transcatheter aortic valve replacement (TAVR). There were 582 patients with severe native aortic stenosis who underwent TAVR consecutively enrolled in the study. The formula used to determine SHR was as follows: admission blood glucose (mmol/L)/(1.59×HbA1c[%]–2.59). The primary endpoint was defined as all-cause mortality, while secondary endpoints included a composite of cardiovascular mortality or readmission for heart failure, and major adverse cardiovascular events (MACE) including cardiovascular mortality, non-fatal myocardial infarction, and non-fatal stroke. Multivariable Cox regression and restricted cubic spline analysis were employed to assess the relationship between SHR and endpoints, with hazard ratios (HRs) and 95% confidence intervals (CIs). During a median follow-up of 3.9 years, a total of 130 cases (22.3%) of all-cause mortality were recorded. Results from the restricted cubic spline analysis indicated a linear association between SHR and all endpoints (p for non-linearity > 0.05), even after adjustment for other confounding factors. Per 0.1 unit increase in SHR was associated with a 12% (adjusted HR: 1.12, 95% CI: 1.04–1.21) higher incidence of the primary endpoint, a 12% (adjusted HR: 1.12, 95% CI: 1.02–1.22) higher incidence of cardiovascular mortality or readmission for heart failure, and a 12% (adjusted HR: 1.12, 95% CI: 1.01–1.23) higher incidence of MACE. Subgroup analysis revealed that SHR had a significant interaction with diabetes mellitus with regard to the risk of all-cause mortality (p for interaction: 0.042). Kaplan-Meier survival analysis showed that there were significant differences in the incidence of all endpoints between the two groups with 0.944 as the optimal binary cutoff point of SHR (all log-rank test: p < 0.05). Our study indicates linear relationships of SHR with the risk of all-cause mortality, cardiovascular mortality or readmission for heart failure, and MACE in patients with severe aortic stenosis receiving TAVR after a median follow-up of 3.9 years. Patients with an SHR exceeding 0.944 had a poorer prognosis compared to those with lower SHR values.

中文翻译：

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应激性高血糖比对接受经导管主动脉瓣置换术的重度主动脉瓣狭窄患者的预后影响：一项前瞻性队列研究

应激性高血糖比（SHR）最近被认为是一种新型生物标志物，可以准确反映急性高血糖状态，并与心力衰竭的不良预后相关。我们评估了接受经导管主动脉瓣置换术 (TAVR) 的严重主动脉瓣狭窄患者的 SHR 与临床结果之间的关系。连续纳入 582 例接受 TAVR 的严重自体主动脉瓣狭窄患者。 SHR计算公式为：入院血糖（mmol/L）/（1.59×HbA1c[%]–2.59）。主要终点被定义为全因死亡率，而次要终点包括心血管死亡率或心力衰竭再入院以及主要不良心血管事件（MACE）（包括心血管死亡率、非致命性心肌梗死和非致命性中风）的复合终点。采用多变量 Cox 回归和限制三次样条分析来评估 SHR 和终点之间的关系，以及风险比 (HR) 和 95% 置信区间 (CI)。在中位随访 3.9 年期间，总共记录了 130 例（22.3%）全因死亡病例。受限三次样条分析的结果表明，即使在调整其他混杂因素之后，SHR 与所有端点之间也存在线性相关性（非线性 p > 0.05）。 SHR 每增加 0.1 个单位，主要终点发生率就会增加 12%（调整后 HR：1.12，95% CI：1.04–1.21），增加 12%（调整后 HR：1.12，95% CI：1.02–1.22）心血管死亡率或因心力衰竭再入院的发生率较高，MACE 发生率较高 12%（调整后 HR：1.12，95% CI：1.01–1.23）。亚组分析显示，在全因死亡风险方面，SHR 与糖尿病存在显着的交互作用（交互作用 p：0.042）。 Kaplan-Meier 生存分析显示，两组之间所有终点的发生率均存在显着差异，SHR 的最佳二元截止点为 0.944（所有对数秩检验：p < 0.05）。我们的研究表明，在中位随访 3.9 年后接受 TAVR 的严重主动脉瓣狭窄患者中，SHR 与全因死亡率、心血管死亡率或心力衰竭再入院风险以及 MACE 呈线性关系。与 SHR 值较低的患者相比，SHR 超过 0.944 的患者预后较差。