Early Anesthesia-Period Stress Hyperglycemia Ratio and In-Hospital Mortality After Noncardiac Surgery in Patients with HbA1c and Glucose Measurements
- 1Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, Beijing 100144, China
- 2Department 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
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.
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BibTeX
@article{zhang2026early,
title = {{Early Anesthesia-Period Stress Hyperglycemia Ratio and In-Hospital Mortality After Noncardiac Surgery in Patients with HbA1c and Glucose Measurements}},
author = {Jianhao Zhang and Yuguan Zhang and Lingxin Wei},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208002},
url = {https://www.mdpi.com/2077-0383/15/20/8002},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Early Anesthesia-Period Stress Hyperglycemia Ratio and In-Hospital Mortality After Noncardiac Surgery in Patients with HbA1c and Glucose Measurements
AU - Jianhao Zhang
AU - Yuguan Zhang
AU - Lingxin Wei
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208002
UR - https://www.mdpi.com/2077-0383/15/20/8002
AB - 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.
SN - 2077-0383
ER -