Combined assessment with stress hyperglycemia ratio and time in range: Associations with twenty-eight-day mortality in surgical intensive care unit patients

BACKGROUND The stress hyperglycemia ratio (SHR) reflects patients’ acute hyperglycemia status, and the time in range (TIR) captures glucose control dynamics during their intensive care unit (ICU) stays. AIM To investigate the independent and combined associations of SHR and TIR with 28-day mortality among surgical ICU patients. METHODS In total, 706 adult patients with available glucose data were included. SHR was calculated as the ratio of admission glucose levels to glycosylated hemoglobin-derived estimated average glucose. TIR was calculated as percentages of glucose readings within the 3.9-10.0 mmol/L range during the ICU stay. SHR and TIR were divided into quartiles, and patients were allocated to four groups according to combinations of high/low values. The associations of the SHR, TIR, and both combined with mortality were assessed using logistic regression. RESULTS Logistic regression analysis demonstrated that patients in the highest SHR quartile had a significantly increased risk of 28-day mortality compared with the reference quartile [adjusted odds ratio (OR) = 2.24; 95% confidence interval (CI): 1.06-4.71; P = 0.033]. In contrast, higher TIR were associated with a reduced risk of 28-day mortality. Compared with the lowest TIR quartile (Q1), adjusted ORs in Q2, Q3, and Q4 were 0.43 (95%CI: 0.23-0.93; P = 0.030), 0.43 (95%CI: 0.19-0.99; P = 0.046), and 0.41 (95%CI: 0.17-0.98; P = 0.045), respectively. When the SHR and TIR were analyzed in combination, patients with high SHR and low TIR had the highest risk of 28-day mortality (adjusted OR = 2.19; 95%CI: 1.05-4.58; P = 0.038). CONCLUSION Combined SHR and TIR assessment offers prognostic value in surgical ICU patients. Maintaining glucose within the target range may be important to improve short-term outcomes in patients with stress hyperglycemia.