BMC cardiovascular disorders · 2026
Association between stress hyperglycemia ratio and in-hospital mortality in acute myocardial infarction: a dose-response meta-analysis.
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Wang Wei, Li Qing, Shu Lingling, Wu Xiaoli, Cui Tiantian, Xu Zhuolin, Chen Zhengjin
Аннотация
BACKGROUND: Stress hyperglycemia ratio (SHR) represents the degree of acute glycemic stress relative to chronic glycemic control. Although SHR has been proposed as a better prognostic marker than absolute glucose levels, its quantitative relationship with in-hospital mortality in acute myocardial infarction (AMI) remains uncertain.
METHODS: A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted up to August 10, 2025. Observational studies reporting the association between SHR and in-hospital mortality in AMI were included. Quality assessment was performed using the Newcastle-Ottawa Scale. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with a random-effects model. The dose-response relationships were analyzed using the Greenland and Longnecker method and restricted cubic spline models.
RESULTS: Eleven studies involving 27,343 patients were included. Higher SHR was significantly associated with increased in-hospital mortality (pooled OR = 2.14; 95% CI: 1.74-2.55; I² = 63%; P < 0.001). The association remained basically consistent across subgroups and sensitivity analysis. Furthermore, the restricted cubic spline model illustrated a non-linear dose-response association between SHR and in-hospital mortality.
CONCLUSIONS: In patients with AMI, an elevated SHR is consistently and non-linearly associated with a higher risk of in-hospital mortality. These findings suggest that SHR may serve as a valuable prognostic tool for early risk stratification, although further prospective studies are needed to confirm its clinical utility.
METHODS: A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted up to August 10, 2025. Observational studies reporting the association between SHR and in-hospital mortality in AMI were included. Quality assessment was performed using the Newcastle-Ottawa Scale. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with a random-effects model. The dose-response relationships were analyzed using the Greenland and Longnecker method and restricted cubic spline models.
RESULTS: Eleven studies involving 27,343 patients were included. Higher SHR was significantly associated with increased in-hospital mortality (pooled OR = 2.14; 95% CI: 1.74-2.55; I² = 63%; P < 0.001). The association remained basically consistent across subgroups and sensitivity analysis. Furthermore, the restricted cubic spline model illustrated a non-linear dose-response association between SHR and in-hospital mortality.
CONCLUSIONS: In patients with AMI, an elevated SHR is consistently and non-linearly associated with a higher risk of in-hospital mortality. These findings suggest that SHR may serve as a valuable prognostic tool for early risk stratification, although further prospective studies are needed to confirm its clinical utility.