Stress hyperglycemia ratio is associated with neurological outcome after cardiac arrest

This study examined the association between glycemic parameters, including absolute glucose and stress hyperglycemia ratio (SHR), and neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors. We conducted a retrospective analysis using data from a prospective, multicenter registry comprising 743 adult comatose OHCA survivors. Glycemic measurements (glucose and SHR) were collected following return of spontaneous circulation (ROSC) and during the subsequent 24-hour period. The primary outcome was poor neurological outcome at 6 months. Subgroup analyses were stratified by glycemic status (HbA1c) and injury severity (the revised Post-Cardiac Arrest Syndrome for Therapeutic Hypothermia score). Both absolute glucose and SHR—measured after ROSC and as 24-hour means—were independently associated with poor neurological outcomes. Among these, SHR during the 24-hour post-ROSC period showed the most substantial predictive value (OR, 2.232; 95% CI, 1.316–3.785). Spline analysis revealed a linear relationship for SHR, contrasting with the U- or J-shaped curves observed for absolute glucose values. Prognostic significance was primarily observed in patients without pre-existing diabetes and those with moderate injury severity. The SHR measured after ROSC and during the first 24 h post-resuscitation is an independent predictor of poor neurological outcome in OHCA survivors. This association is most pronounced in non-diabetic and moderate-severity groups. Kew Words: Cardiac arrest; Hyperglycaemia; Stress Hyperglycaemia Ratio; Neurological outcome.