Prognostic Value of Stress Hyperglycemia Ratio in Critically Ill Patients

NCT07853911 | Not Yet Recruiting

• 1 other identifier: Prognostic Value of SHR in ICU
• Study Type: observational
• Target: 230
• Locations: 0 countries
• Sites: N/A

Brief Summary

Critically ill patients admitted to intensive care units (ICUs) frequently develop elevated blood sugar levels (hyperglycemia) as a result of acute illness-related stress, even if they do not have diabetes. While high blood glucose in the ICU is known to be associated with complications such as acute kidney injury and increased mortality, absolute glucose measurements alone may not distinguish acute stress from pre-existing chronic elevation. The Stress Hyperglycemia Ratio (SHR) evaluates the relative increase in blood glucose by dividing admission plasma glucose by the patient's estimated background average glucose derived from glycated hemoglobin (HbA1c). This measurement reflects the intensity of acute physiologic stress adjusted for baseline glycemic control. The purpose of this prospective observational study is to evaluate the prognostic utility of admission Stress Hyperglycemia Ratio in adult critically ill patients admitted to the intensive care units of Assiut University Hospitals. The study aims to determine whether admission SHR can predict in-hospital ICU mortality, acute kidney injury (AKI), the severity of acute organ failure measured by Sequential Organ Failure Assessment (SOFA) scores, the requirement and duration of invasive mechanical ventilation and vasopressor support, and the overall length of ICU stay. All participants will receive standard clinical care in accordance with institutional ICU protocols; no experimental drugs or clinical interventions will be administered as part of this study.

Conditions

Critical Illness; Hyperglycemia; Acute Kidney Injury; Multiple Organ Failure

Keywords

Stress Hyperglycemia Ratio; SHR; Intensive Care Unit; SOFA Score; In-Hospital Mortality; Glycemic Control; Mechanical Ventilation

Outcome Measures

Primary Outcomes (1)

• Number of Participants With In-Hospital ICU Mortality

  All-cause mortality occurring during the index ICU stay. Vital status (alive or deceased) will be recorded from patient medical records upon discharge from the intensive care unit.

  Up to 30 days

Study Arms (2)

High Stress Hyperglycemia Ratio (High SHR) Group

Adult critically ill patients admitted to the ICU whose admission Stress Hyperglycemia Ratio (SHR) - calculated as admission plasma glucose divided by estimated average glucose (eAG = 28.7 \* HbA1c - 46.7) - falls at or above the optimal cutoff determined by receiver operating characteristic (ROC) analysis. Participants receive standard medical care per ICU protocols without experimental intervention.

Low Stress Hyperglycemia Ratio (Low SHR) Group

Adult critically ill patients admitted to the ICU whose admission Stress Hyperglycemia Ratio (SHR) - calculated as admission plasma glucose divided by estimated average glucose (eAG = 28.7 \* HbA1c - 46.7) - falls below the optimal cutoff determined by receiver operating characteristic (ROC) analysis. Participants receive standard medical care per ICU protocols without experimental intervention.

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adult critically ill patients aged 18 years or older admitted to the Intensive Care Units (ICUs) at Assiut University Hospitals who are expected to require intensive care management, with available admission plasma glucose and early HbA1c measurements.

You may qualify if:

• Adult patients aged 18 years or older.
• Admitted to the intensive care unit (ICU) and expected to require ICU care.
• Availability of admission plasma glucose measurement.
• Availability of glycated hemoglobin (HbA1c) measurement during the early period of ICU admission to calculate estimated average glucose (eAG) and Stress Hyperglycemia Ratio (SHR).
• Provision of written informed consent by the patient or their legally authorized representative.

You may not qualify if:

• Patients younger than 18 years of age.
• Presence of diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) at admission.
• Conditions known to render HbA1c measurement unreliable (such as recent major blood transfusion or known hemoglobinopathies).
• Incomplete essential laboratory or clinical data required for the calculation of SHR or study outcome assessment.
• Patients transferred from another ICU after prolonged critical illness where baseline admission parameters cannot be reliably obtained.
• Refusal of participation or refusal of consent by the patient or legally authorized representative.

Sponsors & Collaborators

• Assiut University: lead

MeSH Terms

Conditions

Critical Illness; Hyperglycemia; Acute Kidney Injury; Multiple Organ Failure

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Renal Insufficiency; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Shock

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Resident

Study Record Dates

• First Submitted: September 27, 2026
• First Posted: October 2, 2026
• Study Start: October 1, 2026
• Primary Completion (Estimated): October 1, 2027
• Study Completion (Estimated): November 1, 2027
• Last Updated: October 2, 2026

Record last verified: 2026-09