In critically ill patients with heart failure and diabetes, SHR exhibits a parabolic (U-shaped) association with 28-day all-cause mortality, with the lowest risk at an SHR of 1.0 and significantly increased risk above this level.
The overall 28-day mortality rate among critically ill patients with heart failure and diabetes was 12.1%.
A U-shaped (parabolic) relationship was found between stress hyperglycemia ratio (SHR) and 28-day mortality risk, with the lowest risk occurring at an SHR of 1.0.
Patients in the lowest SHR quartile (Q1) and highest SHR quartile (Q4) had significantly elevated hazard ratios for 28-day mortality compared to the reference quartile.
Subgroup analyses revealed no statistically significant interactions between SHR and other variables in relation to 28-day mortality.
The stress hyperglycemia ratio (SHR) was calculated and used as the exposure variable to assess acute glucose dysregulation relative to chronic glycemic levels in critically ill patients.
This research suggests that in critically ill patients who have both heart failure and diabetes, the relationship between blood sugar stress (measured by a metric called the stress hyperglycemia ratio, or SHR) and the risk of dying within 28 days follows a U-shaped curve. The SHR compares a patient's blood sugar at hospital admission to their long-term average blood sugar, helping doctors distinguish between temporary stress-related high blood sugar and chronic high blood sugar. Among 1,697 intensive care patients drawn from a large U.S. hospital database, about 12% died within 28 days. Patients with either very low or very high SHR values faced a greater risk of death, while those with an SHR around 1.0 had the lowest risk. Notably, having an SHR above 1.0 was associated with a roughly 70% higher risk of 28-day death compared to those at the inflection point, and patients in the highest SHR group had more than twice the mortality hazard compared to the reference group. This suggests that acute stress-related blood sugar elevations beyond a person's typical baseline carry meaningful prognostic information in this vulnerable patient population. This research suggests that monitoring SHR in critically ill heart failure patients with diabetes may help clinicians identify those at highest risk of early death. The U-shaped pattern is particularly important because it indicates that both abnormally low and abnormally high SHR values signal danger—not just high blood sugar alone. Further research would be needed to determine whether targeting an SHR near 1.0 through clinical interventions could improve outcomes.
Huang Q, Peng Y, Xiao L, Zhang S, Lu Z, Lin H. (2026). A parabolic correlation between stress hyperglycemia ratio and 28-day mortality in US participants with diabetes and heart failure.. Medicine. https://doi.org/10.1097/MD.0000000000050235