{
  "abstract": "Background/Objectives: We examined the association between early anesthesia-period relative hyperglycemia and in-hospital mortality after noncardiac surgery. Methods: This retrospective INSPIRE cohort included admissions with pre-anesthesia HbA1c and glucose measured within 60 min after anesthesia start. Early iSHR was first glucose divided by HbA1c-derived estimated average glucose; whole-anesthesia peak iSHR was secondary. Follow-up extended from anesthesia end until death or same-admission discharge, with variable duration. Logistic spline and linear models used patient-clustered standard errors. Results: Of 117,429 source admissions, 10,406 were included, with 101 deaths. The core-adjusted OR per 0.10 increase in early iSHR was 1.134 (95% CI 1.063–1.210). Further adjustment for measurement count, renal function, malignancy, hypotension, and blood-product records yielded an OR of 1.089 (1.014–1.170) in 10,352 admissions with 97 deaths. For whole-anesthesia peak iSHR (11,374 admissions; 104 deaths), otherwise matched models without and with low-MAP proportion and blood-product records yielded ORs of 1.126 (1.063–1.193) and 1.064 (0.999–1.133; p = 0.052), respectively. A separate TWA/count model yielded an OR of 1.039 (0.973–1.109) in 11,312 admissions. Internal comparisons showed no clear discrimination advantage over absolute early glucose. Conclusions: In clinically selected patients with pre-anesthesia HbA1c and early glucose measurements, early iSHR was associated with in-hospital mortality in core and further-adjusted models, although creatinine-complete and influence analyses indicated limited robustness. The whole-anesthesia peak-iSHR estimate attenuated and showed no clear association when hypotension and blood-product records were included; the TWA/count model also showed no clear association. Internal comparison did not establish a predictive advantage over absolute early glucose; causality cannot be inferred.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, Beijing 100144, China",
    "Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Jianhao Zhang",
      "orcid": "0009-0009-8198-5625"
    },
    {
      "affs": [
        1
      ],
      "name": "Yuguan Zhang",
      "orcid": "0000-0003-4149-8370"
    },
    {
      "affs": [
        0
      ],
      "name": "Lingxin Wei"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1g1tbwwncmvxc.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15208002",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706281/?tool=EBI",
  "id": "1g1tbwwncmvxc",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/20/8002",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2712|Hyperglycemia and glycemic control in critically ill and hospitalized patients"
    ]
  ],
  "openalex": "W7222236998",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706281/pdf/?tool=EBI",
  "pmcid": "PMC13706281",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/1g1tbwwncmvxc.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:00Z",
      "native_id": "10.3390/jcm15208002",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/20/8002"
    },
    {
      "first_seen": "2026-10-30T12:21:47Z",
      "native_id": "PMC:PMC13706281",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13706281"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2712|Hyperglycemia and glycemic control in critically ill and hospitalized patients",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Early Anesthesia-Period Stress Hyperglycemia Ratio and In-Hospital Mortality After Noncardiac Surgery in Patients with HbA1c and Glucose Measurements",
  "title_text": "Early Anesthesia-Period Stress Hyperglycemia Ratio and In-Hospital Mortality After Noncardiac Surgery in Patients with HbA1c and Glucose Measurements",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:47Z",
  "url": "https://research.draconitic.com/paper/1g1tbwwncmvxc",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}