Independent effects of the stress hyperglycemia ratio on in-hospital mortality in nondiabetic and diabetic patients with heart failure: A retrospective, observational, cohort study

Objectives: Stress hyperglycemia ratio (SHR), a novel marker reflecting the true acute hyperglycemic status, is a recognized prognostic factor for cardiovascular disease morbidity and mortality in many patient cohorts. However, its prognostic value in patients with heart failure (HF) has not been established. This study aimed to clarify the association between SHR and in-hospital mortality in patients with HF. Methods: This retrospective study included consecutive patients diagnosed with HF at the Shengjing Hospital of China Medical University between January 2015 and December 2018. SHR was determined by the following formula: Admission blood glucose (mg/dL) / [(28.7 × hemoglobin A1c %) - 46.7]. Patients were categorized into two groups according to the primary endpoint, which was all-cause mortality during hospitalization, and into three groups according to the SHR tertiles. The association between SHR and in-hospital mortality was assessed using logistic regression analysis and further exploring whether SHR could enhance the prognostic efficacy of the Get with the Guidelines-Heart Failure (GWTG-HF) score. In the subgroup analysis, primary endpoint events were explored according to the diabetes status. Results: Among the included 4554 patients, 199 (4.4%) in-hospital mortality events were recorded. The in-hospital mortality rate increased with increasing SHR tertiles. After adjustment for multiple confounders, patients in the Tertile 3 group (SHR≥1.10) exhibited a higher likelihood of experiencing the primary endpoint than that in the Tertile 1 group (SHR<0.93) (odds ratio, 2.417; 95% confidence interval, 1.632–3.580; P <0.001). Moreover, SHR improved the prognostic performance of the GWTG-HF score (absolute integrated discrimination improvement=0.028, P <0.001; category-free net reclassification improvement=0.391, P <0.001). In the subgroup analysis, SHR was associated with in-hospital mortality regardless of the diabetes status. Conclusion: SHR is a potential prognostic index for in-hospital mortality in patients with HF that is independent of the diabetes status. It may be combined with the GWTG-HF score to further improve its prognostic performance.