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ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Cardiovascular Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1558352
Unveiling the role of stress hyperglycemia in predicting mortality for critically ill hemorrhagic stroke patients: insights from MIMIC-IV
Provisionally accepted- 1 Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health；Department of Pharmacology, Graduate School of Medicine, Chiba University, Chiba, Japan
- 2 The Department of Oncology, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, China
- 3 Department of Plastic and Aesthetic, Jintang First People's Hospital, Sichuan University, Jintang County, Sichuan Province, China
- 4 Department of Neurosurgery, Mianyang Central Hospital, Mianyang, Sichuan Province, China
Hemorrhagic stroke (HS), including intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), is associated with high mortality and morbidity. Stress hyperglycemia ratio (SHR), reflecting acute glycemic responses relative to baseline glucose levels, has been linked to poor outcomes in critical illnesses. However, research on its prognostic significance in HS patients admitted to the intensive care unit (ICU) is limited. This study aims to assess the association between SHR and all-cause mortality (ACM) in critically ill HS patients.Patients diagnosed with HS were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database using ICD-9/10 codes. SHR was calculated as [admission glucose (mg/dL) / (28.7 × HbA1c (%) -46.7)]. Patients were stratified into tertiles. Primary outcomes were ICU, in-hospital, 30-day, 90-day, 180-day, and 1-year mortality. Cox regression and restricted cubic splines (RCS) evaluated the dose-response relationship between SHR and ACM. Kaplan-Meier (K-M) analysis assessed survival across tertiles, with subgroup analysis and interaction tests for effect modification.The study included 1,749 patients, with a median age of 68 years (IQR: 57-79), and 53.2% were male. The observed mortality rates were 10.6% in the ICU, 15.2% in-hospital, 19.6% at 30 days, 24.2% at 90 days, 27.8% at 180 days, and 31.7% at 1 year. Multivariate Cox regression analysis indicated that elevated SHR was independently associated with increased ACM at 30 days (adjusted hazard ratio [aHR]: 1.41; 95% confidence interval [
Keywords: Stress hyperglycemia ratio, hemorrhagic stroke, prognosis, MIMIC-IV database, All-cause mortality
Received: 10 Jan 2025; Accepted: 31 Mar 2025.
Copyright: © 2025 Yue, Li, Sun, Wang, Li and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Zongping Li, Department of Neurosurgery, Mianyang Central Hospital, Mianyang, 621000, Sichuan Province, China
Ye Zhang, Department of Neurosurgery, Mianyang Central Hospital, Mianyang, 621000, Sichuan Province, China
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