Prognostic value of stress hyperglycemia ratio on short- and long-term mortality after acute myocardial infarction

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Abstract

Aims

Prior studies demonstrated an association between hospital admission blood glucose and mortality in acute myocardial infarction (AMI). Because stress hyperglycemia ratio (SHR) has been suggested as a more reliable marker of stress hyperglycemia this study investigated to what extent SHR in comparison with admission blood glucose is associated with short- and long-term mortality in diabetic and non-diabetic AMI patients.

Methods

The analysis was based on 2,311 AMI patients aged 25–84 years from the population-based Myocardial Infarction Registry Augsburg (median follow-up time 6.5 years [IQR: 4.9–8.1]). The SHR was calculated as admission glucose (mg/dl)/(28.7 × HbA1c (%)—46.7). Using logistic and COX regression analyses the associations between SHR and admission glucose and mortality were investigated.

Result

Higher admission glucose and higher SHR were significantly and nonlinearly associated with higher 28-day mortality in AMI patients with and without diabetes. In patients without diabetes, the AUC for SHR was significantly lower than for admission glucose (SHR: 0.6912 [95%CI 0.6317–0.7496], admission glucose: 0.716 [95%CI 0.6572–0.7736], p-value: 0.0351). In patients with diabetes the AUCs were similar for SHR and admission glucose. Increasing admission glucose and SHR were significantly nonlinearly associated with higher 5-year all-cause mortality in AMI patients with diabetes but not in non-diabetic patients. AUC values indicated a comparable prediction of 5-year mortality for both measures in diabetic and non-diabetic patients.

Conclusions

Stress hyperglycemia in AMI patients plays a significant role mainly with regard to short-term prognosis, but barely so for long-term prognosis, underlining the assumption that it is a transient dynamic disorder that occurs to varying degrees during the acute event, thereby affecting prognosis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00592-022-01893-0.

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Most cited references 33

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Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes.

Guillermo E. Umpierrez, Scott Isaacs, Niloofar Bazargan … (2002)

Admission hyperglycemia has been associated with increased hospital mortality in critically ill patients; however, it is not known whether hyperglycemia in patients admitted to general hospital wards is associated with poor outcome. The aim of this study was to determine the prevalence of in-hospital hyperglycemia and determine the survival and functional outcome of patients with hyperglycemia with and without a history of diabetes. We reviewed the medical records of 2030 consecutive adult patients admitted to Georgia Baptist Medical Center, a community teaching hospital in downtown Atlanta, GA, from July 1, 1998, to October 20, 1998. New hyperglycemia was defined as an admission or in-hospital fasting glucose level of 126 mg/dl (7 mmol/liter) or more or a random blood glucose level of 200 mg/dl (11.1 mmol/liter) or more on 2 or more determinations. Hyperglycemia was present in 38% of patients admitted to the hospital, of whom 26% had a known history of diabetes, and 12% had no history of diabetes before the admission. Newly discovered hyperglycemia was associated with higher in-hospital mortality rate (16%) compared with those patients with a prior history of diabetes (3%) and subjects with normoglycemia (1.7%; both P < 0.01). In addition, new hyperglycemic patients had a longer length of hospital stay, a higher admission rate to an intensive care unit, and were less likely to be discharged to home, frequently requiring transfer to a transitional care unit or nursing home facility. Our results indicate that in-hospital hyperglycemia is a common finding and represents an important marker of poor clinical outcome and mortality in patients with and without a history of diabetes. Patients with newly diagnosed hyperglycemia had a significantly higher mortality rate and a lower functional outcome than patients with a known history of diabetes or normoglycemia.

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Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview.

S. Capes, D. Hunt, K. Malmberg … (2000)

High blood glucose concentration may increase risk of death and poor outcome after acute myocardial infarction. We did a systematic review and meta-analysis to assess the risk of in-hospital mortality or congestive heart failure after myocardial infarction in patients with and without diabetes who had stress hyperglycaemia on admission. We did two searches of MEDLINE for English-language articles published from 1966 to October, 1998, a computerised search of Science Citation Index from 1980 to September, 1998, and manual searches of bibliographies. Two searchers identified all cohort studies or clinical trials reporting in-hospital mortality or rates of congestive heart failure after myocardial infarction in relation to glucose concentration on admission. We compared the relative risks of in-hospital mortality and congestive heart failure in hyperglycaemic and normoglycaemic patients with and without diabetes. 14 articles describing 15 studies were identified. Patients without diabetes who had glucose concentrations more than or equal to range 6.1-8.0 mmol/L had a 3.9-fold (95% CI 2.9-5.4) higher risk of death than patients without diabetes who had lower glucose concentrations. Glucose concentrations higher than values in the range of 8.0-10.0 mmol/L on admission were associated with increased risk of congestive heart failure or cardiogenic shock in patients without diabetes. In patients with diabetes who had glucose concentrations more than or equal to range 10.0-11.0 mmol/L the risk of death was moderately increased (relative risk 1.7 [1.2-2.4]). Stress hyperglycaemia with myocardial infarction is associated with an increased risk of in-hospital mortality in patients with and without diabetes; the risk of congestive heart failure or cardiogenic shock is also increased in patients without diabetes.

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Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic Patients: A Systematic Overview

D. Hunt, H Gerstein, P. Pathak … (2001)

"Stress" hyperglycemia may be associated with increased mortality and poor recovery in diabetic and nondiabetic patients after stroke. A systematic review and meta-analysis of the literature relating acute poststroke glucose levels to the subsequent course were done to summarize and quantify this relationship.

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Author and article information

Contributors

T. Schmitz:

ORCID: http://orcid.org/0000-0002-3619-0438

timo.schmitz@med.uni-augsburg.de

Journal

Journal ID (nlm-ta): Acta Diabetol

Journal ID (iso-abbrev): Acta Diabetol

Title: Acta Diabetologica

Publisher: Springer Milan (Milan )

ISSN (Print): 0940-5429

ISSN (Electronic): 1432-5233

Publication date (Electronic): 9 May 2022

Publication date PMC-release: 9 May 2022

Publication date (Print): 2022

Volume: 59

Issue: 8

Pages: 1019-1029

Affiliations

[1 ]GRID grid.419801.5, ISNI 0000 0000 9312 0220, Chair of Epidemiology, , University of Augsburg, University Hospital Augsburg, ; Stenglinstraße 2, 86156 Augsburg, Germany

[2 ]GRID grid.419801.5, ISNI 0000 0000 9312 0220, Department of Cardiology, Respiratory Medicine and Intensive Care, , University Hospital Augsburg, ; Augsburg, Germany

[3 ]GRID grid.419801.5, ISNI 0000 0000 9312 0220, KORA Study Centre, , University Hospital of Augsburg, ; Augsburg, Germany

[4 ]GRID grid.4567.0, ISNI 0000 0004 0483 2525, Institute for Epidemiology, , Helmholtz Zentrum München, ; Ingolstädter Landstr. 1, 85764 Neuherberg, Germany

[5 ]GRID grid.5252.0, ISNI 0000 0004 1936 973X, Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, , Ludwig-Maximilians-Universität München, ; Munich, Germany

[6 ]GRID grid.452622.5, German Center for Diabetes Research (DZD), ; Neuherberg, Germany

[7 ]GRID grid.4567.0, ISNI 0000 0004 0483 2525, Independent Research Group Clinical Epidemiology, , Helmholtz Zentrum München, ; Ingolstädter Landstr. 1, 85764 Neuherberg, Germany

Author notes

Managed by Massimo Federici.

Author information

T. Schmitz http://orcid.org/0000-0002-3619-0438

Article

Publisher ID: 1893

DOI: 10.1007/s00592-022-01893-0

PMC ID: 9242951

PubMed ID: 35532812

SO-VID: ed2acee6-d713-4736-88d6-f1990eed7758

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 13 December 2021

Date accepted : 9 April 2022

Funding

Funded by: Helmholtz Zentrum München, German Research Center for Environmental Health

Funded by: German Federal Ministry of Health

Funded by: Faculty of Medicine, University of Augsburg

Funded by: University Hospital of Augsburg

Funded by: Universität Augsburg (3144)

Open Access :

Open Access funding enabled and organized by Projekt DEAL.

Custom metadata

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: stress hyperglycemia,admission glucose,myocardial infarction,short-term mortality,long-term mortality

Data availability:

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: stress hyperglycemia, admission glucose, myocardial infarction, short-term mortality, long-term mortality

Prognostic value of stress hyperglycemia ratio on short- and long-term mortality after acute myocardial infarction

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Trace Elements and Electrolytes

Most cited references 33

Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes.

Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview.

Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic Patients: A Systematic Overview

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