Nonlinear association between stress hyperglycemia ratio and short-term and long-term mortality in sepsis patients with atrial fibrillation: a cohort study.
The stress hyperglycemia ratio (SHR) demonstrates mortality associations across various populations; however, its nonlinear relationship with mortality in the specific subgroup of sepsis with atrial fibrillation (AF) remains insufficiently characterized.
Retrospective cohort of sepsis patients with AF from Medical Information Mart for Intensive Care (MIMIC) -IV version 3.1 database. SHR was calculated as the ratio of admission glucose to estimated average glucose derived from hemoglobin A1c (HbA1c). Nonlinear associations between SHR and 30-day/365-day mortality were assessed using restricted cubic spline (RCS) and threshold effect analyses with multivariable adjustment and entropy balancing weighting.
Among 2,297 participants (median age 73.64 years, 63.2% male), 337 (14.67%) and 629 (27.38%) experienced 30-day and 365-day mortality. Nonlinear associations were identified between SHR and mortality, with inflection points at 0.70 (30-day) and 0.89 (365-day). Below thresholds, SHR was inversely associated with 30-day (HR = 0.10, 95% CI: 0.02-0.47, P = 0.003) and 365-day mortality (HR = 0.40, 95% CI: 0.20-0.78, P = 0.008). Above thresholds, mortality risk increased (30-day HR = 3.24, 95% CI: 2.19-4.80, P < 0.001; 365-day HR = 2.60, 95% CI: 1.80-3.76, P < 0.001). Entropy balancing weighting confirmed these threshold effects.
A nonlinear relationship exists between SHR and mortality in sepsis patients with AF, where both extremely low and high SHR values may increase mortality risk.
Retrospective cohort of sepsis patients with AF from Medical Information Mart for Intensive Care (MIMIC) -IV version 3.1 database. SHR was calculated as the ratio of admission glucose to estimated average glucose derived from hemoglobin A1c (HbA1c). Nonlinear associations between SHR and 30-day/365-day mortality were assessed using restricted cubic spline (RCS) and threshold effect analyses with multivariable adjustment and entropy balancing weighting.
Among 2,297 participants (median age 73.64 years, 63.2% male), 337 (14.67%) and 629 (27.38%) experienced 30-day and 365-day mortality. Nonlinear associations were identified between SHR and mortality, with inflection points at 0.70 (30-day) and 0.89 (365-day). Below thresholds, SHR was inversely associated with 30-day (HR = 0.10, 95% CI: 0.02-0.47, P = 0.003) and 365-day mortality (HR = 0.40, 95% CI: 0.20-0.78, P = 0.008). Above thresholds, mortality risk increased (30-day HR = 3.24, 95% CI: 2.19-4.80, P < 0.001; 365-day HR = 2.60, 95% CI: 1.80-3.76, P < 0.001). Entropy balancing weighting confirmed these threshold effects.
A nonlinear relationship exists between SHR and mortality in sepsis patients with AF, where both extremely low and high SHR values may increase mortality risk.