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Background <p>Postoperative delirium(POD) is severe in elderly cardiac surgery patients.Elevated glucose levels trigger oxidative stress, endothelial dysfunction, and cerebral metabolic disturbances, which are key mechanisms linking dysglycemia to delirium. Current models lack predictors, and dysglycemia interpretation is confounded by diabetes. The stress hyperglycemia ratio (SHR) integrates acute glucose and glycated hemoglobin (HbA1c) to quantify acute metabolic stress, but its predictive value for POD needs validation.</p> Methods <p>This was a multicenter retrospective cohort study involving elderly patients (≥ 65&#xa0;years) admitted to the ICU following cardiac surgery. The discovery cohort was derived from the MIMIC-IV database (<i>n</i> = 1,087), while the external validation cohort consisted of patients from six Chinese hospitals (<i>n</i> = 982). The primary outcome was POD. The optimal threshold for the SHR was identified using restricted cubic splines (RCS). Subsequently, the independent association between SHR and POD was evaluated via multivariable logistic regression with sequential covariate adjustment. The performance of the prediction model based on this threshold was assessed using the receiver operating characteristic curve (ROC), calibration plots, and decision curve analysis. To further ensure the robustness of the findings, we performed propensity score matching (PSM) and comprehensive subgroup analyses.</p> Results <p>RCS analysis revealed a nonlinear relationship between the SHR and the risk of POD, with an inflection point at 1.09. After extensive covariate adjustment, an SHR ≥ 1.09 was strongly and independently associated with a significantly increased risk of POD (adjusted odds ratio [aOR], 4.152; 95% CI, 3.054–5.676, <i>P</i> &lt; 0.001). This robust association was consistently validated in the external cohort (aOR, 3.856; 95% CI, 2.687–5.593, <i>P</i> &lt; 0.001) and persisted in the PSM analysis. Notably, the univariate model based solely on continuous SHR exhibited good discriminative performance (area under the curve [AUC] 0.734), along with favorable calibration and clinical utility, compared with conventional severity scores, indicating SHR’s potential value for risk stratification.</p> Conclusion <p>An elevated SHR (≥ 1.09) was independently associated with a higher odds of POD in elderly cardiac surgery patients. This readily calculable metric may help identify patients at increased risk and guide enhanced monitoring or future intervention trials.</p>

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Stress hyperglycemia ratio is associated with delirium in elderly cardiac surgery patients in the postoperative intensive care unit: a multicenter retrospective cohort study

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  • 发表日期：

    2026年8月5日

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  • Wei Da,
  • Luyao Huang,
  • Shu Zhou,
  • Hong Wei,
  • Yihong Yang,
  • Juan Wang,
  • Hong Zhang

摘要

Background

Postoperative delirium(POD) is severe in elderly cardiac surgery patients.Elevated glucose levels trigger oxidative stress, endothelial dysfunction, and cerebral metabolic disturbances, which are key mechanisms linking dysglycemia to delirium. Current models lack predictors, and dysglycemia interpretation is confounded by diabetes. The stress hyperglycemia ratio (SHR) integrates acute glucose and glycated hemoglobin (HbA1c) to quantify acute metabolic stress, but its predictive value for POD needs validation.

Methods

This was a multicenter retrospective cohort study involving elderly patients (≥ 65 years) admitted to the ICU following cardiac surgery. The discovery cohort was derived from the MIMIC-IV database (n = 1,087), while the external validation cohort consisted of patients from six Chinese hospitals (n = 982). The primary outcome was POD. The optimal threshold for the SHR was identified using restricted cubic splines (RCS). Subsequently, the independent association between SHR and POD was evaluated via multivariable logistic regression with sequential covariate adjustment. The performance of the prediction model based on this threshold was assessed using the receiver operating characteristic curve (ROC), calibration plots, and decision curve analysis. To further ensure the robustness of the findings, we performed propensity score matching (PSM) and comprehensive subgroup analyses.

Results

RCS analysis revealed a nonlinear relationship between the SHR and the risk of POD, with an inflection point at 1.09. After extensive covariate adjustment, an SHR ≥ 1.09 was strongly and independently associated with a significantly increased risk of POD (adjusted odds ratio [aOR], 4.152; 95% CI, 3.054–5.676, P < 0.001). This robust association was consistently validated in the external cohort (aOR, 3.856; 95% CI, 2.687–5.593, P < 0.001) and persisted in the PSM analysis. Notably, the univariate model based solely on continuous SHR exhibited good discriminative performance (area under the curve [AUC] 0.734), along with favorable calibration and clinical utility, compared with conventional severity scores, indicating SHR’s potential value for risk stratification.

Conclusion

An elevated SHR (≥ 1.09) was independently associated with a higher odds of POD in elderly cardiac surgery patients. This readily calculable metric may help identify patients at increased risk and guide enhanced monitoring or future intervention trials.