Risk analysis and mediation analysis of stress hyperglycemia ratio and all-cause mortality in patients with acute kidney injury.

Abstract

Background: Stress hyperglycemia ratio (SHR) has been associated with increased mortality from various cerebrovascular events and a higher incidence of acute kidney injury (AKI) in certain patient populations. However, the relationship between SHR and the mortality risk in patients with AKI has not been fully elucidated. Our study sought to comprehensively investigate the association and potential mediating effects between SHR and 28-day and 90-day mortality in patients with AKI.

Methods: 3703 patients with AKI were included in this study. Feature importance variables were screened by a random forest algorithm, and the independent association of SHR with mortality risk was determined by Kaplan ‒ Meier survival analysis with Cox regression analysis. Restricted cubic spline (RCS) was conducted to assess the non-linear relationship between SHR and mortality risk. Mediation analysis was deployed to investigate the indirect effect of SHR on respiratory failure (RF) -mediated mortality risk.

Results: Among the patients with AKI included in this study, the 28-day mortality was 13.6% and the 90-day mortality was 18.7%. Fully adjusted Cox regression demonstrated that SHR was an independent risk factor for 28-day mortality (HR, 1.77 [95% CI 1.38-2.27], P < 0.001) and 90-day mortality (HR, 1.69 [95% CI 1.36-2.11], P < 0.001) in patients with AKI. RCS analysis revealed a linear relationship between SHR and outcome events. Additionally, the effect of SHR on 28-day and 90-day mortality risk were mediated by an increased RF risk in 6.62% and 6.54%, respectively.

Conclusion: High SHR is an independent risk factor for 28-day and 90-day mortality in patients with AKI, and its effect is partly mediated by an increased risk of RF.