Stress hyperglycemia ratio as an independent predictor of acute kidney injury in critically ill patients with acute myocardial infarction: a retrospective U.S. cohort study

Acute kidney injury (AKI) is a frequent and severe complication in critically ill patients with acute myocardial infarction (AMI), significantly worsening prognosis. Identifying early risk markers for AKI in AMI patients is critical for timely intervention. The stress hyperglycemia ratio (SHR), a marker of acute glycemic response to physiological stress, has been proposed as a predictor of AKI, but its role remains unclear. This study investigates the association between SHR and AKI development in critically ill patients with AMI, using data from the MIMIC-III and MIMIC-IV databases. A total of 4,663 critically ill AMI patients were analyzed. SHR was evaluated for its association with AKI incidence using logistic regression, restricted cubic splines, and mediation analysis. Subgroup and sensitivity analyses were performed to confirm robustness. Additionally, Cox regression and Kaplan-Meier survival analysis were used to explore SHR’s association with in-hospital mortality in the overall cohort and AKI subgroup. Higher SHR levels were independently associated with an increased risk of AKI, demonstrating a J-shaped relationship. Mediation analysis revealed that neutrophil count and albumin partially mediated this effect. Kaplan-Meier survival curves showed significant differences in in-hospital mortality among SHR quartiles (log-rank <i>p</i> &lt; 0.001). However, Cox regression analysis indicated that SHR was not an independent predictor of in-hospital mortality in either the full cohort or the AKI subgroup. SHR serves as an early and independent marker for AKI risk in critically ill AMI patients, offering potential utility in clinical risk stratification. However, its role in predicting in-hospital mortality appears limited. These findings underscore the importance of glycemic monitoring and management in AMI patients at risk of AKI.

急性肾损伤（Acute kidney injury, AKI）是急性心肌梗死（acute myocardial infarction, AMI）重症患者常见且严重的并发症，可显著恶化患者预后。识别AMI患者发生AKI的早期风险标志物，对于及时开展临床干预至关重要。应激性高血糖比值（stress hyperglycemia ratio, SHR）作为反映机体对生理应激的急性血糖反应的标志物，曾被提议作为AKI的预测因子，但其具体作用仍不明确。本研究基于MIMIC-III与MIMIC-IV数据库的数据，探讨了急性心肌梗死重症患者中SHR与AKI发生的关联。本研究共纳入4663例急性心肌梗死重症患者进行分析。通过Logistic回归、限制性立方样条与中介分析，评估了SHR与AKI发生率的关联；并开展亚组分析与敏感性分析以验证结果的稳健性。此外，本研究还采用Cox回归与Kaplan-Meier生存分析，探究了全队列及AKI亚组中SHR与住院死亡率的关联。研究结果显示，较高的SHR水平与AKI风险升高呈独立相关，二者呈现J型关联。中介分析表明，中性粒细胞计数与白蛋白部分介导了该效应。Kaplan-Meier生存曲线显示，SHR四分位数分组的住院死亡率存在显著差异（对数秩检验p<0.001）。但Cox回归分析提示，无论是在全队列还是AKI亚组中，SHR均并非住院死亡率的独立预测因子。综上，SHR可作为急性心肌梗死重症患者发生AKI风险的早期独立标志物，有望应用于临床风险分层。但其在预测住院死亡率方面的作用较为有限。本研究结果凸显了对存在AKI风险的急性心肌梗死患者开展血糖监测与管理的重要性。