Stress hyperglycemia ratio-integrated index and 28-day mortality in sepsis: a dual-cohort study
- 1Department of Proctology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
- 2Department of Emergency, Xuanwu Hospital, Capital Medical University
- 3Department of Emergency, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
Abstract
Background: Stress hyperglycemia is common in sepsis, but admission glucose is influenced by antecedent glycemia. The stress hyperglycemia ratio-integrated index (SHRI) combines hemoglobin A1c (HbA1c)-normalized glycemia with serum potassium. We examined the association between early SHRI and 28-day mortality in adults with sepsis.
Methods: This retrospective dual-cohort study included 4,495 adults with Sepsis-3-defined sepsis from the Medical Information Mart for Intensive Care (MIMIC-IV) database and 320 patients from an independent hospital validation cohort. SHRI was calculated using HbA1c measured from 90 days before to 24 hours after intensive care unit (ICU) admission and glucose and potassium measured within 6 hours before or after ICU admission; the same exposure definition was applied in both cohorts. The primary outcome was 28-day all-cause mortality. Multivariable Cox proportional hazards models adjusted for age, sex, previously diagnosed diabetes, and day-1 Sequential Organ Failure Assessment (SOFA) score, and restricted cubic splines characterized dose–response associations.
Results: Within 28 days, 903 patients (20.1%) died in MIMIC-IV and 64 (20.0%) died in the validation cohort. In MIMIC-IV, the adjusted hazard ratio per 0.1 increase in SHRI was 1.07 (95% confidence interval [CI], 1.04–1.11). The corresponding hazard ratio in the validation cohort was 2.00 (95% CI, 1.36–2.94). Restricted cubic spline analyses showed an overall association in both cohorts, with a nonlinear pattern in MIMIC-IV and an approximately linear pattern in the validation cohort.
Conclusion: Higher early SHRI was associated with higher 28-day mortality in both sepsis cohorts. SHRI may complement established severity measures as an integrated marker of relative hyperglycemia and potassium status.
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BibTeX
@article{liu2026stress,
title = {{Stress hyperglycemia ratio-integrated index and 28-day mortality in sepsis: a dual-cohort study}},
author = {Wenyang Liu and Yanlong Zhao and Chang Liu and Muwen Qu},
journal = {Frontiers in Endocrinology},
year = {2026},
month = nov,
doi = {10.3389/fendo.2026.1985955},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1985955/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Stress hyperglycemia ratio-integrated index and 28-day mortality in sepsis: a dual-cohort study
AU - Wenyang Liu
AU - Yanlong Zhao
AU - Chang Liu
AU - Muwen Qu
PY - 2026
DA - 2026/11/04
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1985955
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1985955/full
AB - Background: Stress hyperglycemia is common in sepsis, but admission glucose is influenced by antecedent glycemia. The stress hyperglycemia ratio-integrated index (SHRI) combines hemoglobin A1c (HbA1c)-normalized glycemia with serum potassium. We examined the association between early SHRI and 28-day mortality in adults with sepsis. Methods: This retrospective dual-cohort study included 4,495 adults with Sepsis-3-defined sepsis from the Medical Information Mart for Intensive Care (MIMIC-IV) database and 320 patients from an independent hospital validation cohort. SHRI was calculated using HbA1c measured from 90 days before to 24 hours after intensive care unit (ICU) admission and glucose and potassium measured within 6 hours before or after ICU admission; the same exposure definition was applied in both cohorts. The primary outcome was 28-day all-cause mortality. Multivariable Cox proportional hazards models adjusted for age, sex, previously diagnosed diabetes, and day-1 Sequential Organ Failure Assessment (SOFA) score, and restricted cubic splines characterized dose–response associations. Results: Within 28 days, 903 patients (20.1%) died in MIMIC-IV and 64 (20.0%) died in the validation cohort. In MIMIC-IV, the adjusted hazard ratio per 0.1 increase in SHRI was 1.07 (95% confidence interval [CI], 1.04–1.11). The corresponding hazard ratio in the validation cohort was 2.00 (95% CI, 1.36–2.94). Restricted cubic spline analyses showed an overall association in both cohorts, with a nonlinear pattern in MIMIC-IV and an approximately linear pattern in the validation cohort. Conclusion: Higher early SHRI was associated with higher 28-day mortality in both sepsis cohorts. SHRI may complement established severity measures as an integrated marker of relative hyperglycemia and potassium status.
SN - 1664-2392
ER -