A nonlinear relationship exists between stress hyperglycemia ratio (SHR) and mortality in sepsis patients with atrial fibrillation, where both extremely low and high SHR values may increase mortality risk.
The study population consisted of 2,297 sepsis patients with atrial fibrillation with notable 30-day and 365-day mortality rates.
SHR demonstrated a nonlinear (rather than linear) association with both 30-day and 365-day mortality in sepsis patients with AF.
Below the SHR inflection thresholds, higher SHR was inversely associated with both 30-day and 365-day mortality.
Above the SHR inflection thresholds, higher SHR was positively associated with both 30-day and 365-day mortality.
SHR was calculated as the ratio of admission glucose to estimated average glucose derived from HbA1c, allowing it to reflect acute-on-chronic glycemic stress.
This research examined the relationship between a measure called the stress hyperglycemia ratio (SHR) and death risk in ICU patients who had both sepsis (a life-threatening response to infection) and atrial fibrillation (an irregular heart rhythm). SHR compares a patient's blood sugar at hospital admission to their estimated long-term average blood sugar, helping distinguish a sudden spike in blood sugar due to illness stress from a patient's usual blood sugar levels. The study used data from nearly 2,300 patients in a large medical database. The researchers found that the relationship between SHR and death was not a simple straight line. Instead, there were specific 'tipping points': below a certain SHR value, having a lower ratio was actually associated with higher death risk; but above that tipping point, a higher ratio was strongly associated with greater death risk. This U-shaped or J-shaped pattern applied to both short-term (30-day) and longer-term (1-year) mortality, with the tipping points occurring at slightly different SHR values for each timeframe. The findings held up even after the researchers used statistical techniques to account for differences between patient groups. This research suggests that monitoring SHR in sepsis patients with atrial fibrillation could be clinically meaningful, as both unusually low and unusually high SHR values appear linked to worse outcomes. The finding that very low SHR (meaning the patient's acute blood sugar is not much higher than their chronic average) is also associated with increased risk may be particularly notable, as it implies that failing to mount a normal stress glucose response could be harmful. These results may help clinicians better identify high-risk patients, though further prospective studies would be needed to determine how this information should guide treatment decisions.
Liang X, Li Y, Gui S. (2026). Nonlinear association between stress hyperglycemia ratio and short-term and long-term mortality in sepsis patients with atrial fibrillation: a cohort study.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1920813