Association between stress hyperglycemia ratio and prognosis of patients hospitalized with COVID ‐19: A meta‐analysis

Aims/introduction Stress hyperglycemia ratio (SHR), calculated by dividing admission glucose levels by estimated chronic glucose levels, has emerged as a novel marker of glycemic stress. However, its prognostic value in patients hospitalized with COVID‐19 remains unclear. This meta‐analysis investigates the association between SHR and adverse outcomes in this population. Materials and Methods A comprehensive literature search was conducted in PubMed, Embase, and Web of Science databases for relevant observational studies. The primary outcome was a composite of ICU admission, invasive mechanical ventilation (IMV), and all‐cause in‐hospital mortality. Secondary outcomes included the individual components of the primary outcome. A random effects model was used to pool the results by incorporating heterogeneity. Results Seven studies involving 2,272 patients were included. Patients with a high SHR had a significantly higher risk of poor composite outcomes (risk ratio [RR]: 1.93, 95% confidence interval [CI]: 1.54–2.43; I 2 = 56%). Subgroup analyses according to study country, age, sex, diabetic status, and cutoff of SHR showed consistent results ( P for subgroup difference all >0.05). Secondary analyses revealed increased risks of ICU admission (RR: 1.77), IMV (RR: 1.87), and in‐hospital mortality (RR: 2.25) in patients with a high SHR at admission. Conclusions High SHR at admission is independently associated with poor prognosis in patients hospitalized with COVID‐19. However, as admission glucose levels in most studies were not standardized for fasting status, SHR may be influenced by postprandial hyperglycemia, which should be considered when interpreting its prognostic value.