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A stress-induced hyperglycemia ratio (SHR) of greater than or equal to 1.1 is associated with increased in-hospital mortality for patients staying in non-resuscitation ICUs, according to study findings published in Clinical Therapeutics.
Researchers conducted a retrospective cohort study using the MIMIC-III database, an open-source platform with data on more than 50,000 ICU admissions to Beth Israel Deaconess Medical Center in Boston, Massachusetts, from 2008 to 2014. A total of 46,570 patients admitted to the ICU were identified for inclusion.
Participants were excluded if they were younger than age 18 years, had died or were discharged within 24 hours of admission, had not their glucose or hemoglobin A1c levels recorded on admission, or were treated in a resuscitation ICU. A total of 1859 patients met the inclusion criteria for the study. This cohort was then divided into 2 groups based on whether their SHR was greater than or equal to 1.1 (n=790) or less than 1.1 (n=1069).
It was observed that participants in the group who had SHRs of greater than or equal to 1.1 experienced a significantly higher in-hospital mortality rate compared with those in the group whose SHRs were less than 1.1 (13.7% and 7.4%, respectively; P <.001). Secondary outcomes measured included the percentage of patients who required vasopressor use, the ICU length of stay, the general hospital length of stay, and the need for mechanical ventilation.
Participants with SHRs greater than or equal to 1.1 required vasopressors at a significantly higher rate vs participants with SHRs less than 1.1 (23.7% and 17.1%, respectively; P =.002). They also experienced significantly longer ICU lengths of stay (2.88 days [95% CI, 1.81-5.68] and 2.17 days [95% CI, 1.48-4.03], respectively; P <.001) and hospital lengths of stay (6.91 days [95% CI, 4.15-12.22] and 6.09 days [95% CI, 3.73-10.68], respectively; P =.001). Lastly, they had a significantly higher mean length of time on mechanical ventilators than those in the group with SHRs less than 1.1 (0.00 hours [95% CI, 0.00-14.17] and 0.00 hours [95% CI, 0.00-35.38], respectively; P <.001).
Limitations of the study include the single-center design, which limits the generalizability of the results. Because the data were retrieved from a public database, there were instances of missing or possibly incorrect data values.
The researchers conclude, “[S]tress-induced hyperglycemia, as evaluated using SHR, was associated with increased in-hospital mortality and worse clinical outcomes in critically ill patients in the nonresuscitation ICU.”
