Stress hyperglycaemia ratio (SHR) showed a J-shaped connection with in-hospital and 1-year deaths in hypertension patients admitted to ICUs, suggesting SHR can predict mortality in individuals with critical hypertension.
SHR as a continuous variable was independently associated with increased in-hospital mortality in hypertensive ICU patients.
SHR as a continuous variable was independently associated with increased 1-year mortality in hypertensive ICU patients.
Patients in the highest SHR quartile (Q4) had substantially elevated in-hospital and 1-year mortality compared to lower quartiles.
The relationship between SHR and both in-hospital and 1-year mortality followed a J-shaped non-linear pattern.
The study enrolled 2,088 hypertensive ICU patients from the MIMIC-IV database with defined mortality outcomes.
This research examined whether the stress hyperglycaemia ratio (SHR) — a measure that compares a person's blood sugar at hospital admission to their usual long-term blood sugar level (estimated from HbA1c) — could predict the risk of death in patients with high blood pressure who were admitted to intensive care units. Using data from over 2,000 such patients in the MIMIC-IV database, the researchers found that higher SHR values were linked to significantly greater chances of dying both during the hospital stay and within one year of admission. Patients in the highest quarter of SHR values were more than three times as likely to die in the hospital compared to those in lower SHR groups. A particularly important finding was that the relationship between SHR and mortality was not a simple straight line. Instead, it followed a J-shaped pattern, meaning that mortality risk remained relatively stable at lower SHR levels but rose sharply once SHR passed a certain point. This suggests there may be a critical threshold beyond which stress-related blood sugar elevation becomes especially dangerous for critically ill hypertensive patients. This research suggests that SHR — which can be calculated from routine blood tests already taken at admission — could be a practical and cost-free tool to help identify hypertensive ICU patients who are at the highest risk of dying. Because it accounts for a patient's usual blood sugar baseline rather than just a single high reading, it may provide more meaningful information than blood glucose alone, potentially supporting earlier or more targeted treatment decisions for these high-risk individuals.
Zhao D, Wang F, Ding Y, Gu X. (2026). J‑shaped link of stress hyperglycaemia ratio with in-hospital and 1-year mortality in hypertension patients: based on the MIMIC-IV database.. Blood pressure. https://doi.org/10.1080/08037051.2026.2709810