Relative hyperglycemia, a marker of critical illness: Introducing the stress hyperglycemia ratio

Abstract

Context: Hyperglycemia in hospitalized patients is associated with increased morbidity and mortality. Objective: We examined whether critical illness is more strongly associated with relative or absolute hyperglycemia. Design: The study was an observational cohort study. Patients and Setting: A total of 2290 patients acutely admitted to a tertiary hospital. MainOutcomeMeasure: The relative hyperglycemia (stress hyperglycemia ratio [SHR])wasdefined as admission glucose divided by estimated average glucose derived from glycosylated hemoglobin. The relationships between glucose and SHR with critical illness (in-hospital death or critical care) were examined. Results: In univariable analyses, SHR (odds ratio, 1.23 per 0.1 increment [95% confidence interval, 1.18-1.28]; P < .001) SHR quintiles than in the lowest SHR quintile. Conclusions: SHR controls for background glycemia and is a better biomarker of critical illness than absolute hyperglycemia. SHR identifies patients with relative hyperglycemia at risk of critical illness. Future studies should explore whether basing glucose-lowering therapy on relative, rather than absolute, hyperglycemia improvesoutcomesin hospitalized patients.