Abstract
INTRODUCTION: The association between relative hyperglycemia and postoperative delirium (POD) following coronary artery bypass grafting (CABG) remains inadequately understood. This research aims to explore the correlation between the stress hyperglycemia ratio (SHR) and the occurrence of delirium in patients undergoing CABG. METHODS: This study analyzed the data from 9613 patients who underwent coronary artery bypass grafting (CABG) using information from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. To assess the association between SHR and POD following CABG, restricted cubic spline (RCS) models and logistic regression analyses were applied. Patients were categorized into high SHR (SHR ≥ 1.21) and low SHR (SHR < 1.21) groups based on optimal cut-off values derived from the receiver operating characteristic (ROC) curve. To evaluate the influence of diabetes mellitus (DM) on the outcomes, further classified of four groups of patients were conducted based on the presence or absence of DM and SHR levels. Subgroup analyses were subsequently applied to assess the relationship of POD and SHR within various patient groups. RESULTS: The average age of the enrolled patients was 67.62 ± 12.54 years, with 6284 (65.3%) males, higher SHR was associated with an increased incidence of postoperative delirium following CABG (OR 1.37, 95% CI 1.24-1.52, P < 0.001), even after adjusting for confounders (OR 1.55, 95% CI 1.32-1.79, P < 0.001). RCS analysis revealed a "J-shaped" relationship between the POD fowling CABG and SHR level. Logistic regression analysis further demonstrated that the association between SHR and POD may be higher than that of glucose or glycated hemoglobin levels alone. Among the stratified groups based on SHR and DM, the high-SHR/DM group exhibited the highest risk of developing POD. In conclusion, SHR is an independent risk factor that may have potential as a biomarker for assessing POD after CABG. CONCLUSION: SHR serves as an independent risk factor and shows promise as a potential biomarker for predicting the risk of POD following CABG.