The Stress hyperglycemia ratio (SHR) is a novel marker reflecting the true acute hyperglycemia status and is associated with clinical adverse events. The relationship between SHR and mortality in patients with diabetes or prediabetes is still unclear. This study aimed to investigate the predictive value of the SHR for all-cause and cardiovascular mortality in patients with diabetes or prediabetes. This study included 11,160 patients diagnosed with diabetes or prediabetes from the National Health and Nutrition Examination Survey (2005–2018). The study endpoints were all-cause and cardiovascular mortality, and morality data were extracted from the National Death Index (NDI) up to December 31, 2019. Patients were divided into SHR quartiles. Cox proportion hazards regression was applied to determine the prognostic value of SHR. Model 1 was not adjusted for any covariates. Model 2 was adjusted for age, sex, and race. Model 3 was adjusted for age, sex, race, BMI, smoking status, alcohol use, hypertension, CHD, CKD, anemia, and TG. During a mean follow-up of 84.9 months, a total of 1538 all-cause deaths and 410 cardiovascular deaths were recorded. Kaplan-Meier survival analysis showed the lowest all-cause mortality incidence was in quartile 3 (P < 0.001). Multivariate Cox regression analyses indicated that, compared to the 1st quartile, the 4th quartile was associated with higher all-cause mortality (model 1: HR = 0.89, 95% CI 0.74–10.7, P = 0.226; model 2: HR = 1.24, 95% CI 1.03-1.49, P = 0.026; model 3: HR = 1.30, 95% CI 1.08–1.57, P = 0.006). The 3rd quartile was associated with lower cardiovascular mortality than quartile 1 (model 1: HR = 0.47, 95% CI 0.32–0.69, P < 0.001; model 2: HR = 0.66, 95% CI 0.45–0.96, P = 0.032; model 3: HR = 0.68, 95% CI 0.46–0.99, P = 0.049). There was a U-shaped association between SHR and all-cause mortality and an L-shaped association between SHR and cardiovascular mortality, with inflection points of SHR for poor prognosis of 0.87 and 0.93, respectively. SHR is related to all-cause and cardiovascular mortality in patients with diabetes or prediabetes. SHR may have predictive value in those patients.

中文翻译：

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压力高血糖比率对糖尿病或糖尿病前期患者全因死亡率和心血管死亡率的预后价值：来自 NHANES 2005-2018 的见解

应激性高血糖比（SHR）是反映真实急性高血糖状态的新标志物，与临床不良事件相关。SHR 与糖尿病或糖尿病前期患者死亡率之间的关系尚不清楚。本研究旨在探讨 SHR 对糖尿病或糖尿病前期患者全因死亡率和心血管死亡率的预测价值。这项研究纳入了国家健康和营养检查调查（2005-2018）中诊断为糖尿病或糖尿病前期的 11,160 名患者。研究终点是全因死亡率和心血管死亡率，道德数据从截至 2019 年 12 月 31 日的国家死亡指数 (NDI) 中提取。患者被分为 SHR 四分位数。应用 Cox 比例风险回归来确定 SHR 的预后价值。模型 1 未针对任何协变量进行调整。模型 2 根据年龄、性别和种族进行了调整。模型 3 根据年龄、性别、种族、BMI、吸烟状况、饮酒、高血压、CHD、CKD、贫血和 TG 进行了调整。在平均 84.9 个月的随访期间，总共记录了 1538 例全因死亡和 410 例心血管死亡。Kaplan-Meier 生存分析显示，全因死亡率发生率最低的是第 3 个四分位数（P < 0.001）。多变量 Cox 回归分析表明，与第一个四分位数相比，第四个四分位数与更高的全因死亡率相关（模型 1：HR = 0.89，95% CI 0.74–10.7，P = 0.226；模型 2：HR = 1.24， 95% CI 1.03-1.49，P = 0.026；模型 3：HR = 1.30，95% CI 1.08–1.57，P = 0.006）。第三个四分位与较低的心血管死亡率相关（模型 1：HR = 0.47，95% CI 0.32–0.69，P < 0.001；模型 2：HR = 0.66，95% CI 0.45–0.96，P = 0.032；模型3：HR = 0.68，95% CI 0.46–0.99，P = 0.049）。SHR 与全因死亡率之间呈 U 形关联，SHR 与心血管死亡率之间呈 L 形关联，SHR 不良预后的拐点分别为 0.87 和 0.93。SHR 与糖尿病或糖尿病前期患者的全因死亡率和心血管死亡率相关。SHR 可能对这些患者具有预测价值。