The Stress Hyperglycemia Ratio as a Predictor of Short-and Long-Term Mortality in Patients with Acute Brain Injury: A Retrospective Cohort Study

Wang, Juan; Ding, Peng-Fei; Peng, Zheng; Hang, Chunhua; Li, Wei

doi:10.3389/fneur.2025.1552462

ORIGINAL RESEARCH article

Front. Neurol.

Sec. Neurocritical and Neurohospitalist Care

Volume 16 - 2025 | doi: 10.3389/fneur.2025.1552462

This article is part of the Research Topic Genetic Insights and Diagnostic Innovations in Cerebrovascular and Cerebrospinal Fluid Disorders View all 5 articles

The Stress Hyperglycemia Ratio as a Predictor of Short-and Long-Term Mortality in Patients with Acute Brain Injury: A Retrospective Cohort Study

Provisionally accepted

Juan Wang

Peng-Fei Ding

Zheng Peng

Chunhua Hang

Wei Li ^*

Nanjing Drum Tower Hospital, Nanjing, China

The final, formatted version of the article will be published soon.

Background: This study examines the Stress Hyperglycemia Ratio (SHR) as a predictor of mortality in acute brain injury (ABI) patients using the MIMIC-IV v3.1 database.In this retrospective cohort study of 2,423 ABI patients, SHR was calculated as SHR = (Admission blood glucose (mg/dL)) / (28.7 × HbA1c (%) -46.7). Mortality outcomes included ICU, in-hospital, 30-day, 60-day, 90-day, and 365day mortality. Cox regression models adjusted for covariates assessed the association between SHR and mortality risk, with restricted cubic splines confirming linearity.Predictive performance was evaluated using ROC curves, incorporating SHR, Glasgow Coma Scale (GCS), and first-day ventilation status.Results: SHR was significantly associated with mortality across all outcomes, showing a linear relationship. Adjusted hazard ratios (HR) for in-hospital and ICU mortality were 1.18 (95% CI: 1.06-1.32, p=0.003) and 1.16 (95% CI: 1.02-1.32, p=0.029), respectively. Dichotomized SHR indicated increased in-hospital mortality risk (HR: 1.44, 95% CI: 1.13-1.83, p=0.003). Combining SHR with GCS and ventilation status improved predictive accuracy, achieving AUCs of 0.817 for ICU mortality and 0.788 for in-hospital mortality. Robustness was supported by E-values of 2.24 and 2.37 for in-hospital and ICU mortality.SHR independently predicts short-and long-term mortality in ABI patients, with enhanced utility when combined with GCS and ventilation status, supporting its role in clinical risk stratification.

Keywords: Acute brain injury, Stress hyperglycemia ratio (SHR), Linear association, Short-term and long-term mortality, ROC Curve

Received: 28 Dec 2024; Accepted: 07 Apr 2025.

Copyright: © 2025 Wang, Ding, Peng, Hang and Li. 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: Wei Li, Nanjing Drum Tower Hospital, Nanjing, China

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