Stress hyperglycemia ratio is a prognostic marker of severe disturbance of consciousness and adverse survival outcomes in stroke patients

To investigate the independent association of the stress hyperglycemia ratio (SHR) with the risks of severe disturbance of consciousness (SDOC), in-hospital mortality, and 28-day mortality in stroke patients. This single-center retrospective cohort study collected data from the Beth Israel Deaconess Medical Center in Boston, USA between 2008 and 2022. A total of 1836 stroke patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) were enrolled. First, multicollinearity was tested for all continuous independent variables. Then, Cox regression analysis, Kaplan-Meier curves, restricted cubic splines and subgroup analyses were applied to investigate the association between SHR and short-term outcomes in stroke patients. Finally, the robustness of the study results was verified using the Boruta feature selection algorithm and stratified sensitivity analyses. In this study, 223 patients developed SDOC, who had elevated in-hospital and 28-day mortality rates as well as prolonged hospital stays ( p < 0.0001). Analyses of SHR as a continuous variable and by quartile both revealed a positive correlation between SHR levels and the risk of SDOC as well as short-term mortality; additionally, patients in Q4 (the highest SHR quartile) had the longest hospital stays ( p < 0.05). Boruta algorithm analysis revealed that SHR was associated with SDOC, in-hospital mortality and 28-day mortality. Subgroup analyses confirmed the consistency of this association across all subgroups, and the predictive value of SHR for SDOC was independent of stroke type. Stratification by stroke type and sensitivity analysis after excluding diabetic patients both yielded consistent findings. Elevated SHR is an independent predictor of SDOC and short-term mortality in stroke patients, and may serve as a valuable risk stratification marker in this population.