Cox proportional hazard ratios.

BackgroundThe stress hyperglycemia ratio (SHR) has been extensively studied; however, its association with severe consciousness disorder (Glasgow Coma Scale [GCS] ≤ 8) in patients with acute ischemic stroke (AIS) remains unclear. This study aimed to evaluate the association between SHR and GCS ≤ 8 in AIS as well as its relationship with long-term mortality.MethodsThis retrospective cohort study based on the MIMIC database. The primary outcome was GCS ≤ 8, and the secondary outcome was long-term mortality. The Cox proportional risk model was used to evaluate the relationship between SHR and outcome, and the restricted cubic spline (RCS) method was used to explore the potential nonlinear relationship between SHR and outcome. In addition, Kaplan-Meier curves were used to assess the differences between SHR levels and the incidence of each outcome.ResultsIn this study, the overall incidence of GCS ≤ 8 and long-term mortality were 8.10% and 28.75%, respectively. Multivariate Cox regression analysis showed that SHR was associated with GCS ≤ 8 (HR = 1.52, 95%CI: 1.09–2.14, P = 0.015) and long-term mortality (HR = 1.32, 95%CI: 1.07–1.61, P ConclusionsElevated SHR was associated with GCS ≤ 8 and long-term mortality in patients with AIS, with a nonlinear relationship for GCS ≤ 8. Further studies are required to confirm these results.

【背景】应激性高血糖比值（stress hyperglycemia ratio, SHR）已被广泛研究，但其与急性缺血性卒中（acute ischemic stroke, AIS）患者的严重意识障碍（格拉斯哥昏迷量表（Glasgow Coma Scale, GCS）≤8分）的关联仍不明确。本研究旨在探讨SHR与AIS患者GCS≤8分的关联，及其与远期死亡率的关系。
【方法】本研究为一项基于MIMIC数据库的回顾性队列研究。主要结局指标为GCS≤8分，次要结局指标为远期死亡率。采用Cox比例风险模型评估SHR与结局的关联，并通过限制性立方样条（restricted cubic spline, RCS）法探究SHR与结局间潜在的非线性关系。此外，采用Kaplan-Meier曲线分析不同SHR水平下各结局事件的发生率差异。
【结果】本研究中，GCS≤8分与远期死亡率的总体发生率分别为8.10%与28.75%。多因素Cox回归分析显示，SHR与GCS≤8分（风险比（Hazard Ratio, HR）=1.52，95%置信区间（Confidence Interval, CI）：1.09~2.14，P=0.015）及远期死亡率（HR=1.32，95%CI：1.07~1.61，P）存在关联。
【结论】急性缺血性卒中患者中，升高的SHR与GCS≤8分及远期死亡率均存在关联，且与GCS≤8分呈现非线性相关关系。仍需开展进一步研究以验证本研究结果。