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Association between stress hyperglycemia ratio with short-term and long-term mortality in critically ill patients with ischemic stroke

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Hyperglycemia on admission is associated with poor prognosis in ischemic stroke (IS) patients. We aimed to investigate the relationship between stress hyperglycemia ratio (SHR) and short-term or long-term mortality in IS patients in the ICU and to explore whether this relationship is influenced by diabetes status.

Materials and methods

We collected patients with severe IS requiring ICU admission in the Medical Information Mart for Intensive Care (MIMIC-IV) database and calculated SHR. Outcomes included 30-day, 90-day, and 1-year mortality. The association between SHR and mortality in patients with critical IS was elucidated using Multivariate Cox regression and subgroup analysis for diabetes.


A total of 1376 patients were recruited. After adjusting for potential confounders, patients in the third and fourth quartiles had a significantly increased risk of death at 30 days, 90 days, and 1 year compared to the first quartile of SHR (Q3 vs. Q1: HR 1.56–1.80, all p < 0.02; Q4 vs. Q1: HR 1.75–2.15, all p < 0.001; all p for trend < 0.001). In addition, the highest quartile of SHR was significantly associated with short-term or long-term mortality compared with the first quartile, regardless of diabetes status.


Our results suggest that stress hyperglycemia, defined by the glucose/HbA1c ratio, is associated with increased short-term and long-term mortality in patients with ischemic stroke, independent of the patient's diabetes status.

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Fig. 1
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Data availability

MIMIC-IV database v2.0 is freely-available on PhysioNet ( The code for data query and extraction is available from the MIMIC Code Repository (



Glycemic variability


Standard deviation


Area under the curves


Receiver operating characteristic


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Authors and Affiliations



HP contributed to conceptualization, methodology, and software. HP and YX done data curation and writing—original draft preparation. HP, YX, and YH helped in visualization and investigation. YH and JZ helped in supervision. JZ and HW done software and validation. HW helped in writing—reviewing and editing.

Corresponding author

Correspondence to Haifang Wan.

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The authors declare that they have no competing interests.

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Not applicable.

Ethics approval and consent to participate

This study was performed by the principals of the Declaration of Helsinki. The use of the MIMIC-IV database was approved by the review committee of the Massachusetts Institute of Technology and Beth Israel Deaconess Medical Center. The data is publicly available (in the MIMIC-IV database) hence ethical approval statements and informed consent are not required for the study.

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Pan, H., Xiong, Y., Huang, Y. et al. Association between stress hyperglycemia ratio with short-term and long-term mortality in critically ill patients with ischemic stroke. Acta Diabetol 61, 859–868 (2024).

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