Stress hyperglycemia ratio and its correlation with long-term prognosis in ACS patients with chronic kidney disease: a retrospective study

Abstract

Background: The Stress Hyperglycemia Ratio (SHR), which serves as an indicator of blood glucose variability in response to acute illness or injury, has been established as a predictor of long-term prognosis for various diseases, particularly those affecting cardiovascular health. However, the relationship between SHR and patients presenting with acute coronary syndrome (ACS) in conjunction with chronic kidney disease (CKD) remains to be fully elucidated. Methods: From January 2013 to December 2019, this study enrolled a total of 465 patients with ACS complicated by CKD at the First Affiliated Hospital of Wenzhou Medical University. Fasting blood glucose (FBG), glycated hemoglobin, and other relevant parameters were recorded for these patients, and they were followed up for major adverse cardiovascular events (MACE). Results: A total of 465 patients were ultimately included, of whom 97 experienced MACE during the follow-up period. Multivariate Cox regression analysis revealed that SHR is an independent risk factor for patients with ACS complicated by CKD. The group with elevated SHR exhibited the highest incidence of MACE, and a nonlinear “J-shaped” relationship was observed between SHR and the risk of MACE, with an inflection point at 0.84. However, no significant heterogeneity was noted in the subgroup analysis. The inclusion of SHR enhances the predictive capability of the GRACE score. Conclusion: SHR serves as a reliable indicator of long-term outcomes in patients with ACS and CKD. Additionally, SHR enhances the prognostic accuracy of the GRACE score for ACS-CKD patients.