Association between stress hyperglycemia ratio and in-hospital mortality in acute myocardial infarction: a dose-response meta-analysis.

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.