Abstract
BACKGROUND: The stress hyperglycemia ratio (SHR) at the time of admission has been linked to short-term adverse outcomes in patients suffering from ischemic stroke (IS). However, the connection between SHR and long-term mortality in cases of IS has yet to be investigated. This study aimed to elucidate the connection between SHR and long-term mortality in IS patients, while also investigating the impact of stratification status on this relationship. METHODS: Data regarding IS patients were extracted from our medical institution's undisclosed internal stroke database, spanning from January 2016 to December 2023. Participants were classified into three groups according to the tertiles of continuous SHR. The primary outcome centered on all-cause mortality over a six-year period, whereas the secondary outcome focused on in-hospital all-cause mortality. Cox regression analysis and Kaplan-Meier curves were utilized to assess the connection between SHR and mortality rates. To further investigate the nature of this relationship, a restricted cubic spline (RCS) analysis was performed to determine its linearity, and an iterative algorithm was employed to pinpoint the inflection points. Variations among the strata were depicted in a subgroup forest plot. The prognostic ability of SHR concerning mortality risk was illustrated through receiver operating characteristic (ROC) curves. RESULTS: Among the 4330 participants, the mean age was 69.3 ± 13.4 years, with 2805 individuals (64.8%) identified as male. SHR was linked to a heightened risk of all-cause mortality at the six-year follow-up (HR 1.605, 95% CI 1.099-2.345) and during hospitalization (HR 3.698, 95% CI 1.950-7.014) (P < 0.05). The RCS analysis uncovered a "U-shaped" nonlinear relationship between SHR and six-year all-cause mortality. Subgroup analyses revealed that, among the non-diabetic cohort, patients devoid of atrial fibrillation, and those who had not undergone endovascular treatment, both low and high SHR significantly elevated the six-year mortality risk compared to moderate SHR. CONCLUSION: This study revealed that SHR is correlated with a heightened risk of six-year and in-hospital all-cause mortality in IS patients. A U-shaped nonlinear association is observed between SHR and six-year all-cause mortality. Therefore, SHR could potentially act as a significant predictor for adverse long-term outcomes in IS patients, thereby facilitating clinical decision-making and risk evaluation.