Establishment of an intraoperative risk stratification model for stress-induced hyperglycemia following liver transplantation: A retrospective cohort study

Stress-induced hyperglycemia (SIH) frequently occurs after liver transplantation, leading to impaired graft recovery and increased morbidity. This study aimed to identify independent intraoperative predictors of SIH and establish a simplified predictive model for early clinical application in non-diabetic transplant recipients. Clinical data from 56 non-diabetic patients undergoing first-time liver transplantation (December 2019–November 2023) were retrospectively analyzed. Logistic regression identified independent predictors of postoperative SIH. A predictive model was developed, validated via receiver operating characteristic (ROC) curve analysis, and visualized with a clinical nomogram. The incidence of SIH was 46.4%. Multivariate analysis identified donor age (OR = 1.06, P = 0.033), anhepatic phase duration (OR = 1.16, P = 0.018), and pre-incision blood glucose (OR = 3.41, P = 0.009) as independent SIH predictors. The combined predictive model showed strong discriminative ability (AUC = 0.922; sensitivity = 84.6%, specificity = 90.0%), surpassing individual predictors. A nomogram was developed for rapid clinical risk assessment. Donor age, anhepatic phase duration, and pre-incision blood glucose independently predict postoperative SIH. This simplified predictive model provides clinicians a practical tool for early identification and targeted management of high-risk patients to mitigate hyperglycemia-related complications.