毛 瑞,李玉英

目的：探讨急性呼吸衰竭（ARF）患者应激性高血糖比值（SHR）与住院死亡风险的关联，明确其作为预后评估潜在指标的价值。方法：纳入MIMIC-IV数据库中首次入住ICU的成年ARF患者1212例，按SHR四分位数分为Q1~Q4组（SHR=入院血糖/[(28.7×糖化血红蛋白HbA1c%)-46.7]）。采用Cox比例风险模型分析相关性，限制性立方样条模型验证关联形态，Kaplan-Meier曲线比较组间死亡差异，主要终点为院内死亡。结果：中位随访13天，院内死亡率21%。RCS模型提示SHR与住院死亡率呈非线性正相关；Cox模型显示Q4组死亡风险较Q1组显著升高；K-M曲线证实组间死亡率存在统计学差异。结论：SHR升高与ARF患者住院死亡风险显著相关，可为预后评估提供参考，但本研究基于MIMIC-IV数据库，结论应用受限，需更大样本量研究进一步验证。

应激性高血糖比值；急性呼吸衰竭；住院死亡率；重症监护医学信息数据库

[1] S.Fujishima,“Guideline-Based Management of Acute Respiratory Failure and Acute Respiratory Distress Syndrome,”Journal of intensive care 11,no.1(2023):10. [2] Azoulay E,Mokart D,Kouatchet A,Demoule A,Lemiale V.Acute respiratory failure in immunocompromised adults[J].Lancet Respir Med,2019,7:173-186. [3] Roberts G W,et al.Relative Hyperglycemia,a Marker of Critical Illness:Introducing the Stress Hyperglycemia Ratio[J].J Clin Endocrinol Metab,2015,100:4490-4497. [4] Umpierrez G E,et al.Hyperglycemia:an independent marker of in-hospital mortality in patients with undiagnosed diabetes[J].J Clin Endocrinol Metab,2002,87:978-982. [5] Xu J,Zhou H,Wang Z.Accelerated biological aging mediates the associations of stress hyperglycemia ratio(SHR)with mortality in type 2 diabetes and obesity(diabesity).Cardiovasc Diabetol 2025;24(1):368. [6] Li Z,Chen R,Zeng Z,Wang P,Yu C,Yuan S et al.Association of stress hyperglycemia ratio with short-term and long-term prognosis in patients undergoing coronary artery bypass grafting across different glucose metabolism states:a large-scale cohort study.Cardiovasc Diabetol 2025;24(1):179. [7] Goldberger A L,et al.PhysioBank,PhysioToolkit,and PhysioNet:components of a new research resource for complex physiologic signals[J].Circulation,2000,101:E215-220. [8] Johnson A E W,et al.MIMIC-IV,a freely accessible electronic health record dataset[J].Sci Data,2023,10:1. [9] Stekhoven D J,Bühlmann P.MissForest--non-parametric missing value imputation for mixed-type data[J].Bioinformatics,2012,28:112-118. [10] Yang Y,et al.The stress hyperglycemia ratio,an index of relative hyperglycemia,as a predictor of clinical outcomes after percutaneous coronary intervention[J].Int J Cardiol,2017,241:57-63. [11] Roberts G W,Quinn S J,Valentine N,Alhawassi T,O'Dea H,Stranks S N,et al.Relative Hyperglycemia,a Marker of Critical Illness: Introducing the Stress Hyperglycemia Ratio[J].J Clin Endocrinol Metab,2015,100(12):4490-4497. [12] Harrell F E Jr,Lee K L,Pollock B G.Regression models in clinical studies:determining relationships between predictors and response[J].J Natl Cancer Inst,1988,80:1198-1202. [13] Dai Z,et al.Impacts of stress hyperglycemia ratio on early neurological deterioration and functional outcome after endovascular treatment in patients with acute ischemic stroke[J].Front Endocrinol(Lausanne),2023,14:1094353. [14] 韩旭,牛凯,刘斌.应激性高血糖比值与脓毒症患者院内死亡风险的关系[J].广西医学,2024,46(07):1021-1026. [15] 董征,杨青苗,郭彩霞.应激性高血糖比值对急性心肌梗死患者院内不良预后的影响[J].首都医科大学学报,2024,45(03):494-500. [16] Chen P C,et al.An Elevated Glycemic Gap is Associated With Adverse Outcomes in Diabetic Patients With Community-Acquired Pneumonia[J].Medicine(Baltimore),2015,94:e1456. [17] Jensen A V,et al.The Glycemic Gap and 90-Day Mortality in Community-acquired Pneumonia.A Prospective Cohort Study[J].Ann Am Thorac Soc,2019,16:1518-1526. [18] 秦梦真,董钰莹,王玲玲,等｡应激性高血糖比值与急性缺血性脑卒中患者并发主要不良心血管事件的关系[J].实用心脑肺血管病杂志,2024,32(11):37-42. [19] LI X H,YANG X L,DONG B B,et al.Predicting 28-day all-cause mortality in patients admitted to intensive care units with pre-existing chronic heart failure using the stress hyperglycemia ratio:A machine learning-driven retrospective cohort analysis[J].Cardiovasc Diabetol,2025,24:10. [20] 翟文亮,邢绣荣,何婧瑜,等｡应激性高血糖比率对老年急性心力衰竭患者短期预后的判断价值[J].中国医刊,2023, 58(10):1146-1149. [21] Edriss H,Selvan K,Sigler M,Nugent K.Glucose Levels in Patients With Acute Respiratory Failure Requiring Mechanical Ventilation[J]. J Intensive Care Med,2017,32(10):578-584. [22] Preiser J C,Ichai C,Orban J C,Groeneveld A B.Metabolic response to the stress of critical illness[J].Br J Anaesth,2014,113(6):945-954. [23] Giacco F,Brownlee M.Oxidative stress and diabetic complications[J].Circ Res,2010,107(9):1058-1070. [24] Ferroni P,Basili S,Falco A,DavìG.Platelet activation in type 2 diabetes mellitus[J].J Thromb Haemost,2004,2(8):1282-1291. [25] Edriss H,Molehin A J,Gavidia R,Selvan K,Nugent K.Association between acute respiratory failure requiring mechanical ventilation and the production of advanced glycation end products[J].J Investig Med,2020,68(7):1235-1240.

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