ArticleDiabetology & metabolic syndrome2025
Association of the stress hyperglycemia ratio for all-cause and cardiovascular mortality in population with cardiovascular-kidney-metabolic syndrome stages 0-4: evidence from a large cohort study.
Article in Diabetology & metabolic syndrome, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Nonlinear relationship between stress hyperglycemic ratio and prognosis in patients with cardiac surgery-related kidney injury: a retrospective cohort study.Renal failure · 2026Article
- Cardiovascular-kidney-metabolic syndrome: a comprehensive review of pathophysiology, epidemiology, diagnosis, and management.Cardiovascular diabetology · 2026Review
- Unveiling the relationship between stress-hyperglycemia ratio and cardiometabolic multimorbidity risk using interpretable machine learning.European journal of medical research · 2026Article
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Abstract
backgroundThe Cardiovascular-kidney-metabolic (CKM) syndrome is a health disorder caused by interactions between cardiovascular disease, kidney disease, and metabolism-related risk factors. The stress hyperglycemia ratio (SHR) has been shown to correlate with the prognosis of participants with diabetes mellitus, heart failure, and myocardial infarction. However, the predictive value of SHR in the CKM syndrome population is unclear and requires further exploration.
methodsThis study analyzed 19,345 participants from the National Health and Nutrition Examination Survey (1999-2018). CKM syndrome was staged according to the American Heart Association (AHA) guidelines. SHR was calculated using fasting blood glucose (FBG) and glycated hemoglobin type A1c (HbA1c). Participants were grouped into four quartiles based on SHR. The primary and secondary outcomes were all-cause mortality and cardiovascular mortality, respectively. Kaplan-Meier survival curves and Cox proportional hazard regression models were used to evaluate the association between SHR and outcomes. Then, the potential nonlinear relationship was explored using restricted cubic spline (RCS) analysis. We also performed subgroup analyses to assess the effects of different variables.
resultsA total of 2,736 all-cause deaths and 699 cardiovascular deaths were recorded during a median follow-up period of 115 months. Kaplan-Meier analysis revealed that participants in quartile 2 had the lowest risk for both all-cause and cardiovascular mortality (Log Rank P < 0.05). Multivariate Cox regression demonstrated the lowest all-cause mortality in the 2nd quartile (HR = 0.84, 95% CI = 0.73-0.97, P = 0.015) and the highest all-cause mortality in the 4th quartile (HR = 1.19, 95% CI = 1.03-1.37, P = 0.018), compared with the 1st quartile group of SHR. The RCS curve demonstrated a U-shape association of SHR with both all-cause and cardiovascular mortality, with the lowest points of 0.89 and 0.91, respectively.
conclusionsSHR is strongly correlated with prognosis in the CKM syndrome population, with high or low SHR increasing the risk of death. This index shows great potential for predicting the risk of death in this population.
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