Predictive performance of stress hyperglycemia ratio for poor prognosis in critically ill patients: a systematic review and dose-response meta-analysis.

Background: Stress hyperglycemia ratio (SHR) refers to the ratio of blood glucose levels to glycated hemoglobin (HbA1c) levels upon admission. As a non-invasive and easily obtainable indicator, there is no systematic evidence-based medical evidence to support the value of SHR in predicting the poor prognosis of critically ill patients at present.

Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched with a December 20, 2024 deadline. Prospective and retrospective cohort studies were included. Two investigators independently screened studies and extracted data. The Newcastle-Ottawa scale was applied to appraise the risk of bias in the studies included. Statistical analysis was executed by means of Stata 15.1 software. Study heterogeneity was assessed with the I statistic. A restricted cubic spline model was leveraged for dose-response analysis. Sensitivity analyses were implemented to verify the stability of the results using the one-by-one exclusion method, and subgroup analyses were conducted with disease types.

Results: 39 studies involving 102,414 patients were included. The meta-analysis revealed that SHR exhibited a noticeable positive link with major adverse cardiovascular events (MACE), 30-day mortality, one-year mortality, cardiovascular mortality (CVM), and all-cause mortality (ACM) in critically ill patients. Dose-response analysis showed that a positive link of SHR with multiple mortality was noted in critically ill patients.

Conclusion: SHR is an independent predictor of mortality in critically ill patients, and its dynamic monitoring could provide essential support for early clinical risk stratification and intervention strategies.