Stress hyperglycemia ratio and short-term mortality in critically ill patients with respiratory diseases: a systematic review and dose-response meta-analysis.
- 1School of Nursing, Ningxia Medical University, Yinchuan, China.
- 2School of Medical Information and Engineering, Ningxia Medical University, Yinchuan, China.
Abstract
Objective
To systematically evaluate the association between the HbA1c-adjusted stress hyperglycemia ratio (SHR) and short-term mortality in patients with severe respiratory diseases and characterize its linear and nonlinear dose-response relationships.Methods
PubMed, Embase, China National Knowledge Infrastructure, Wanfang, VIP, and the Chinese Biomedical Literature Database were searched for observational studies evaluating SHR and short-term mortality, including in-hospital, intensive care unit (ICU), 28-day, or 30-day mortality. Odds ratios (ORs) and hazard ratios (HRs) were pooled separately using random-effects models. Sensitivity analyses, linear dose-response analyses, restricted cubic spline analyses, and exploratory analyses of low and high SHR were performed.Results
Eleven studies were included. Four studies contributed to the OR-based primary meta-analysis. Short-term mortality tended to be higher in the highest SHR category than in the study-specific reference category, but the association was not statistically significant (OR = 2.72, 95% CI: 0.74-9.93, P = 0.091; I ² = 86.4%). Three studies contributed to the HR-based primary meta-analysis, which showed a significant association between higher SHR and increased short-term mortality risk (HR = 1.87, 95% CI: 1.71-2.05, P = 0.001; I ² = 0%). In HR studies, each 0.1-unit increase in SHR was associated with an approximately 5% increase in short-term mortality risk (HR = 1.05, 95% CI: 1.02-1.08, P = 0.023). OR studies showed a similar direction of association but did not reach statistical significance. Restricted cubic spline analyses found no clear evidence of nonlinearity. Exploratory analyses suggested higher risks at both low and high SHR levels, but the estimates were imprecise.Conclusions
Current evidence suggests that higher SHR is associated with increased short-term mortality risk in patients with severe respiratory diseases. HR-based evidence was more consistent and supported a positive linear dose-response relationship. OR-based findings pointed in the same direction but showed substantial heterogeneity and did not reach statistical significance. The available evidence is insufficient to confirm a clear nonlinear pattern. Given the limited number of studies and wide confidence intervals, the apparent increase in risk at both low and high SHR levels should be interpreted as exploratory and does not yet support a stable U-shaped or J-shaped dose-response pattern.Systematic review registration
https://www.crd.york.ac.uk/PROSPERO/view/CRD420261418259, PROSPERO CRD420261418259.
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BibTeX
@article{zhang2026stress,
title = {{Stress hyperglycemia ratio and short-term mortality in critically ill patients with respiratory diseases: a systematic review and dose-response meta-analysis.}},
author = {Wenjie Zhang and Haihong Zhang and Wenxue Zhang and Li Tang},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1937012},
url = {https://europepmc.org/article/MED/42923303},
note = {CC BY},
}
RIS
TY - JOUR
TI - Stress hyperglycemia ratio and short-term mortality in critically ill patients with respiratory diseases: a systematic review and dose-response meta-analysis.
AU - Wenjie Zhang
AU - Haihong Zhang
AU - Wenxue Zhang
AU - Li Tang
PY - 2026
DA - 2026/10/08
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1937012
UR - https://europepmc.org/article/MED/42923303
AB - Objective To systematically evaluate the association between the HbA1c-adjusted stress hyperglycemia ratio (SHR) and short-term mortality in patients with severe respiratory diseases and characterize its linear and nonlinear dose-response relationships.Methods PubMed, Embase, China National Knowledge Infrastructure, Wanfang, VIP, and the Chinese Biomedical Literature Database were searched for observational studies evaluating SHR and short-term mortality, including in-hospital, intensive care unit (ICU), 28-day, or 30-day mortality. Odds ratios (ORs) and hazard ratios (HRs) were pooled separately using random-effects models. Sensitivity analyses, linear dose-response analyses, restricted cubic spline analyses, and exploratory analyses of low and high SHR were performed.Results Eleven studies were included. Four studies contributed to the OR-based primary meta-analysis. Short-term mortality tended to be higher in the highest SHR category than in the study-specific reference category, but the association was not statistically significant (OR = 2.72, 95% CI: 0.74-9.93, P = 0.091; I ² = 86.4%). Three studies contributed to the HR-based primary meta-analysis, which showed a significant association between higher SHR and increased short-term mortality risk (HR = 1.87, 95% CI: 1.71-2.05, P = 0.001; I ² = 0%). In HR studies, each 0.1-unit increase in SHR was associated with an approximately 5% increase in short-term mortality risk (HR = 1.05, 95% CI: 1.02-1.08, P = 0.023). OR studies showed a similar direction of association but did not reach statistical significance. Restricted cubic spline analyses found no clear evidence of nonlinearity. Exploratory analyses suggested higher risks at both low and high SHR levels, but the estimates were imprecise.Conclusions Current evidence suggests that higher SHR is associated with increased short-term mortality risk in patients with severe respiratory diseases. HR-based evidence was more consistent and supported a positive linear dose-response relationship. OR-based findings pointed in the same direction but showed substantial heterogeneity and did not reach statistical significance. The available evidence is insufficient to confirm a clear nonlinear pattern. Given the limited number of studies and wide confidence intervals, the apparent increase in risk at both low and high SHR levels should be interpreted as exploratory and does not yet support a stable U-shaped or J-shaped dose-response pattern.Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261418259, PROSPERO CRD420261418259.
SN - 2296-858X
ER -