Stress Hyperglycemia Ratio (SHR)

SHR calculation: [(Admission blood glucose (mg/dl))/(28.7×HbA1c(%)-46.7)]

There is a paucity of studies examining the SHR index and its prognostic significance in patients with atrial fibrillation (AF)

Assessing the relationship between SHR index and all-cause mortality in patients with severe atrial fibrillation admitted to the intensive care unit

Patient data were extracted from the Medical Information Marketplace for Intensive Care IV (MIMIC-IV) database

Variables with more than 20% missing values ​​were excluded from the analysis

For variables with less than 20% missing values, use the random forest method for data imputation

All patients were divided into four groups according to the SHR index

Results include primary and secondary endpoints, the primary endpoint is 30-day and 365-day all-cause mortality, and the secondary endpoint is 90-day and 180-day all-cause mortality

SHR index was analyzed using quartiles and results were compared between groups using Kaplan-Meier curves

Cox proportional hazards regression and restricted cubic splines (RCS) were used to assess the relationship between SHR index and outcomes

Of the total 1,685 participants, the mean age was 63.12 years (range: 40.17 to 101.49), of whom 1,004 (59.58%) were male

As shown by the KM curve (log-rank P < 0.01), higher levels of SHR index were associated with increased risk of 30-day, 90-day, 180-day, and 365-day all-cause mortality.

Cox proportional hazards regression analysis showed that the risk of death at these time points was significantly higher in the highest quartile of SHR index

RCS analysis showed a U-shaped relationship between the SHR index and all-cause mortality, with an inflection point of 0.73 for 30-day mortality and 0.76 for 365-day mortality.

Compared with patients with SHR levels below these inflection points, patients with higher SHR levels had a 69.9% increased risk of 30-day all-cause death and a 61.6% increased 365-day risk of all-cause death

In critically ill patients with AF, higher levels of SHR index were significantly associated with increased risk of 30-day, 90-day, 180-day, and 365-day all-cause mortality

The SHR index can be used as an effective index to evaluate the severity of atrial fibrillation patients in the ICU and guide treatment.

Baseline characteristics of patients grouped according to SHR index quartiles.

Cox proportional hazards model for 30-day all-cause mortality

Cox proportional hazards model for 365-day all-cause mortality

Analysis of the threshold effect of SHR index on 30-day all-cause mortality in patients with atrial fibrillation

If the association was nonlinear, a recursive algorithm was used to determine the inflection points between SHR index and mortality at 30, 90, 180, and 365 days

A two-stage Cox proportional hazards model was applied on either side of the inflection point

Analysis of the threshold effect of SHR index on 365-day all-cause mortality in patients with atrial fibrillation

Flow of patients included during the trial

KM survival analysis curve of all-cause mortality

RCS of SHR index and all-cause mortality

Forest plot of stratified analysis of SHR index and 30-day all-cause mortality

Forest plot of stratified analysis of SHR index and 365-day all-cause mortality

Four sets of KM curves for 90 and 180 days

RCS of SHR index and all-cause mortality

Forest plot of stratified analysis of SHR index and 90-day all-cause mortality

Forest plot of stratified analysis of SHR index and 180-day all-cause mortality

Cox proportional hazards model for 90-day all-cause mortality

Cox proportional hazards model for 180-day all-cause mortality

Analysis of the threshold effect of SHR index on 90-day all-cause mortality in patients with atrial fibrillation

Analysis of the threshold effect of SHR index on 180-day all-cause mortality in patients with atrial fibrillation