Stress hyperglycemia ratio emerges as a novel independent predictor of acute kidney injury among critically ill patients with acute heart failure: A retrospective analysis of the MIMIC-IV database.

BACKGROUND

Acute kidney injury (AKI) frequently complicates acute heart failure (AHF), predicting worse outcomes. Early risk identification is crucial. The stress hyperglycemia ratio (SHR), reflecting acute dysglycemia, may predict AKI, but its utility in AHF remains unestablished.

MATERIALS AND

METHODS

We analyzed 1,241 AHF patients stratified by SHR. Associations with outcomes were assessed using logistic and Cox regression. The relationship between continuous SHR and AKI development was evaluated with restricted cubic splines (RCS). The primary endpoint was incident AKI during hospitalization.

RESULTS

AKI occurred in 79.7% of patients. After multivariable adjustment, SHR demonstrated a linear association with AKI risk. For 28-day mortality, the relationship with SHR was U-shaped, with an inflection point at 0.841. An SHR > 0.841 was associated with significantly increased mortality (OR = 2.086; 95% CI: 1.368 - 3.182). An elevated SHR was consistently associated with higher AKI risk across all patient subgroups, with an overall adjusted OR of 1.60 (95% CI: 1.15 - 2.22).

CONCLUSION

The study demonstrates a linear association between the SHR and AKI, in contrast to a U-shaped relationship with 28-day in-hospital mortality among AHF patients. An SHR of 0.841 represents a critical threshold for evaluating in-hospital mortality risk.