The prognostic impact of stress hyperglycemia ratio on mortality in cardiogenic shock: a MIMIC-IV database analysis

BACKGROUND: The stress hyperglycemia ratio (SHR) has been established as a predictor of unfavorable outcomes across various diseases. However, its relationship with prognosis in patients with cardiogenic shock (CS) remains unclear. This study aims to investigate the association between SHR and outcomes in CS patients. METHODS: A total of 904 CS patients with their first ICU admission were included in this study, utilizing data from the American Medical Information Mart for Intensive Care (MIMIC-IV) database. The primary endpoints were all-cause mortality at 30 days and 360 days. Patients were stratified into three groups based on the tertiles of the SHR. RESULTS: The mean age of the cohort was 67.62 years, with 67.3% of participants being men. During the follow-up period, 221 patients (24.4%) died within 30 days, and 360 patients (39.8%) died within 360 days. The 30-day all-cause mortality rates were 16.9%, 22.3%, and 34.2% in the T1, T2, and T3 groups, respectively (p < 0.001), while the 360-day all-cause mortality rates were 34.9%, 39.0%, and 45.6%, respectively (p = 0.015). Compared with patients in T1, those in T3 exhibited a significantly higher risk of 30-day all-cause mortality (HR = 2.140, 95% CI: 1.522-3.008, p < 0.001) and 360-day all-cause mortality (HR = 1.495, 95% CI: 1.157-1.931, p = 0.002). Restricted cubic spline (RCS) analyses demonstrated an approximately linear relationship between SHR and 360-day all-cause mortality (p for overall = 0.011; p for nonlinearity = 0.099). However, a nonlinear association was observed between SHR and 30-day all-cause mortality (p for overall < 0.001; p for nonlinearity = 0.030), with the risk increasing significantly when SHR exceeded 1.176. Subgroup analyses revealed that the effect of SHR was consistent across most subgroups except in patients with and without acute myocardial infarction (AMI). In patients with AMI, SHR was associated with a significantly elevated risk of mortality, whereas no significant association was observed in patients without AMI. For 30-day all-cause mortality, the HR was 1.059 (95% CI: 1.040-1.078) in patients with AMI and 1.002 (95% CI: 0.966-1.040) in those without AMI (p for interaction = 0.007). For 360-day all-cause mortality, the HR was 1.043 (95% CI: 1.026-1.061) in patients with AMI and 0.984 (95% CI: 0.955-1.014) in those without AMI (p for interaction < 0.001). CONCLUSION: Elevated SHR was significantly associated with increased 30-day and 360-day all-cause mortality in patients with CS, particularly in those with CS complicated by AMI. SHR may serve as a valuable marker for risk stratification and guiding subsequent interventions in CS patients. However, further prospective studies are needed to confirm these findings.