Stress hyperglycemia ratio as an independent predictor of acute kidney injury in critically ill patients with acute myocardial infarction: a retrospective U.S. cohort study.

IF 3 3区 医学 Q1 UROLOGY & NEPHROLOGY
Renal Failure Pub Date : 2025-12-01 Epub Date: 2025-02-26 DOI:10.1080/0886022X.2025.2471018
Xudong Li, Yong Qiao, Liang Ruan, Shuailei Xu, Zhongguo Fan, Shiqi Liu, Junxian Shen, Chengchun Tang, Yuhan Qin
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Abstract

Background: Acute kidney injury (AKI) is a frequent and severe complication in critically ill patients with acute myocardial infarction (AMI), significantly worsening prognosis. Identifying early risk markers for AKI in AMI patients is critical for timely intervention. The stress hyperglycemia ratio (SHR), a marker of acute glycemic response to physiological stress, has been proposed as a predictor of AKI, but its role remains unclear.

Objective: This study investigates the association between SHR and AKI development in critically ill patients with AMI, using data from the MIMIC-III and MIMIC-IV databases.

Methods: A total of 4,663 critically ill AMI patients were analyzed. SHR was evaluated for its association with AKI incidence using logistic regression, restricted cubic splines, and mediation analysis. Subgroup and sensitivity analyses were performed to confirm robustness. Additionally, Cox regression and Kaplan-Meier survival analysis were used to explore SHR's association with in-hospital mortality in the overall cohort and AKI subgroup.

Results: Higher SHR levels were independently associated with an increased risk of AKI, demonstrating a J-shaped relationship. Mediation analysis revealed that neutrophil count and albumin partially mediated this effect. Kaplan-Meier survival curves showed significant differences in in-hospital mortality among SHR quartiles (log-rank p < 0.001). However, Cox regression analysis indicated that SHR was not an independent predictor of in-hospital mortality in either the full cohort or the AKI subgroup.

Conclusions: SHR serves as an early and independent marker for AKI risk in critically ill AMI patients, offering potential utility in clinical risk stratification. However, its role in predicting in-hospital mortality appears limited. These findings underscore the importance of glycemic monitoring and management in AMI patients at risk of AKI.

应激高血糖率作为急性心肌梗死危重患者急性肾损伤的独立预测因子:一项美国回顾性队列研究
背景:急性肾损伤(AKI)是急性心肌梗死(AMI)危重患者常见且严重的并发症,预后显著恶化。识别AMI患者AKI的早期风险标记对于及时干预至关重要。应激性高血糖比(SHR)是生理应激下急性血糖反应的标志,已被提出作为AKI的预测指标,但其作用尚不清楚。目的:本研究利用MIMIC-III和MIMIC-IV数据库的数据,探讨AMI危重患者SHR与AKI发展之间的关系。方法:对4663例急性心肌梗死危重患者进行分析。使用逻辑回归、受限三次样条和中介分析来评估SHR与AKI发病率的关系。进行亚组分析和敏感性分析以证实稳健性。此外,采用Cox回归和Kaplan-Meier生存分析来探讨SHR与整个队列和AKI亚组住院死亡率的关系。结果:较高的SHR水平与AKI风险增加独立相关,呈j型关系。中介分析显示,中性粒细胞计数和白蛋白部分介导了这一作用。Kaplan-Meier生存曲线显示SHR四分位数在住院死亡率方面存在显著差异(log-rank p)。结论:SHR可作为危重AMI患者AKI风险的早期独立标志物,在临床风险分层中具有潜在的实用价值。然而,它在预测住院死亡率方面的作用似乎有限。这些发现强调了有AKI风险的AMI患者血糖监测和管理的重要性。
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来源期刊
Renal Failure
Renal Failure 医学-泌尿学与肾脏学
CiteScore
3.90
自引率
13.30%
发文量
374
审稿时长
1 months
期刊介绍: Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.
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