Predictive value of stress hyperglycemia ratio for prognosis in acute ischemic stroke patients treated with intravenous thrombolysis

doi:10.3877/cma.j.issn.1673-9248.2026.04.007

Abstract

Abstract:

Objective

To analyze the relationship between the stress hyperglycemia ratio (SHR) and the prognosis of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT).

Methods

This retrospective study included 158 AIS patients who underwent IVT at the First Affiliated Hospital of the University of Science and Technology of China between January 2022 and December 2023. Baseline clinical data were collected via the hospital's electronic medical record system. Patients were divided into a favorable- [modified Rankin scale (mRS) score ≤3] and a poor-prognosis (mRS score ＞3) groups based on neurological recovery at 90 days. Univariate analysis (t-test, Mann-Whitney U test, or χ² test) compared general clinical data and laboratory indicators between the two groups. Univariate Logistic regression identified factors associated with poor prognosis, while multivariate Logistic regression (adjusted for confounders) analyzed the independent association between SHR and IVT outcomes. Restricted cubic spline models further assessed nonlinear associations between SHR and prognosis.

Results

Among 158 AIS patients, 135 (85.4%) had favorable IVT outcomes and 23 (14.6%) had poor outcomes. Compared with the poor-prognosis group, the favorable-prognosis group showed significantly higher levels of albumin [(44.20±4.66) g/L vs (40.24±5.43) g/L, t=3.672, P＜0.001], uric acid [(348.89±95.39) μmol/L vs (305.54±86.36) μmol/L, t=2.041, P=0.043], LDL-C [(2.76±0.89) mmol/L vs (2.35±0.56) mmol/L, t=2.091, P=0.038], total cholesterol [(4.69±1.12) mmol/L vs (4.00±0.70) mmol/L, t=2.780, P=0.006], and aspartate aminotransferase [22.00 (18.00, 28.30) U/L vs 19.00 (15.00, 24.80) U/L, Z=-2.096, P=0.036]. Conversely, the favorable-prognosis group had significantly lower NIHSS scores before thrombolysis [6.00 (3.00, 11.00) vs 16.00 (11.00, 20.00), Z=-4.915, P＜0.001], direct bilirubin [3.20 (2.10, 4.60) μmol/L vs 4.20 (2.90, 5.60) μmol/L, Z=-2.695, P=0.007], and SHR [1.02 (0.89, 1.18) vs 1.19 (1.02, 1.46), Z=-2.576, P=0.010]. Univariate Logistic regression identified SHR (OR=5.184, 95%CI: 1.202 - 22.360), NIHSS score before thrombolysis (OR=1.189, 95%CI: 1.101 - 1.283), albumin (OR=0.830, 95%CI: 0.749 - 0.920), uric acid (OR=0.994, 95%CI: 0.989 - 1.000), LDL-C (OR=0.515, 95%CI: 0.273 - 0.971), total cholesterol (OR=0.467, 95%CI: 0.266 - 0.820), and direct bilirubin (OR=1.483, 95%CI: 1.154 - 1.906) as factors associated with poor prognosis (all P＜0.05). Multivariate analysis confirmed SHR as an independent predictor of poor IVT outcomes after adjusting for confounders. Restricted cubic spline models revealed a nonlinear relationship: when SHR was ＜1.03, the risk of poor prognosis increased slowly with rising SHR; when SHR was ≥1.03, the risk escalated rapidly.

Conclusion

In AIS patients receiving IVT, elevated SHR is independently associated with poor 90-day outcomes.

Key words: Acute ischemic stroke, Intravenous thrombolysis, Stress hyperglycemia ratio, Logistic regression analysis, Outcome

Qiongdan Hu, Shanbing Hou, Xia Chen, Jiaoyuan Wang, Xiaoxi Dai. Predictive value of stress hyperglycemia ratio for prognosis in acute ischemic stroke patients treated with intravenous thrombolysis[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2026, 20(04): 396-402.

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URL: https://zhnxgbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1673-9248.2026.04.007

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Figures/Tables 4

项目	预后良好组（n=135）	预后不良组（n=23）	统计值	P值
性别[例（%）]			χ²=1.699	0.250
男性	84（62.22）	11（47.83）
女性	51（37.78）	12（52.17）
年龄（岁， $x ¯$ ±s）	65.62±12.66	66.96±16.78	t=-0.444	0.657
吸烟史[例（%）]			χ²=0.173	0.807
是	41（30.37）	6（26.09）
否	94（69.63）	17（73.91）
饮酒史[例（%）]			χ²=0.042	0.523
是	44（32.59）	7（30.43）
否	91（67.41）	16（69.57）
溶栓前NIHSS评分[分，M（Q₁，Q₃）]	6.00（3.00，11.00）	16.00（11.00，20.00）	Z=-4.915	＜0.001
白细胞计数（×10⁹/L， $x ¯$ ±s）	7.98±2.76	7.90±2.68	t=0.128	0.898
白蛋白（g/L， $x ¯$ ±s）	44.20±4.66	40.24±5.43	t=3.672	＜0.001
尿酸（μmol/L， $x ¯$ ±s）	348.89±95.39	305.54±86.36	t=2.041	0.043
HDL-C（mmol/L， $x ¯$ ±s）	1.04±0.32	1.06±0.21	t=-0.261	0.795
LDL-C（mmol/L， $x ¯$ ±s）	2.76±0.89	2.35±0.56	t=2.091	0.038
总胆固醇（mmol/L， $x ¯$ ±s）	4.69±1.12	4.00±0.70	t=2.780	0.006
中性粒细胞计数[×10⁹/L，M（Q₁，Q₃）]	4.66（3.69，6.09）	5.68（3.80，7.42）	Z=-1.003	0.316
淋巴细胞计数[×10⁹/L，M（Q₁，Q₃）]	1.83（1.30，2.55）	1.49（0.80，2.30）	Z=-1.521	0.128
单核细胞计数[×10⁹/L，M（Q₁，Q₃）]	0.41（0.31，0.53）	0.36（0.32，0.46）	Z=-1.642	0.100
红细胞计数[×10¹²/L，M（Q₁，Q₃）]	140.00（128.00，150.00）	135.50（117.00，152.00）	Z=-1.287	0.198
血小板计数[×10⁹/L，M（Q₁，Q₃）]	181.50（156.00，224.00）	179.50（167.00，218.00）	Z=-0.690	0.490
ALT[U/L，M（Q₁，Q₃）]	18.00（14.00，26.00）	16.50（13.00，21.00）	Z=-1.599	0.110
AST[U/L，M（Q₁，Q₃）]	22.00（18.00，28.30）	19.00（15.00，24.80）	Z=-2.096	0.036
DBIL[μmol/L，M（Q₁，Q₃）]	3.20（2.10，4.60）	4.20（2.90，5.60）	Z=-2.695	0.007
血肌酐[μmol/L，M（Q₁，Q₃）]	69.50（57.00，86.80）	69.00（60.00，80.00）	Z=-0.227	0.821
尿素氮[mmol/L，M（Q₁，Q₃）]	6.15（5.00，7.40）	5.70（4.40，7.20）	Z=-1.423	0.155
血糖[mmol/L，M（Q₁，Q₃）]	7.32（6.22，9.86）	7.25（6.30，13.64）	Z=-0.560	0.575
甘油三酯[mmol/L，M（Q₁，Q₃）]	1.56（1.13，2.36）	1.40（0.74，1.83）	Z=-1.681	0.093
SHR[M（Q₁，Q₃）]	1.02（0.89，1.18）	1.19（1.02，1.46）	Z=-2.576	0.010

项目	预后良好组（n=135）	预后不良组（n=23）	统计值	P值
性别[例（%）]			χ²=1.699	0.250
男性	84（62.22）	11（47.83）
女性	51（37.78）	12（52.17）
年龄（岁， $x ¯$ ±s）	65.62±12.66	66.96±16.78	t=-0.444	0.657
吸烟史[例（%）]			χ²=0.173	0.807
是	41（30.37）	6（26.09）
否	94（69.63）	17（73.91）
饮酒史[例（%）]			χ²=0.042	0.523
是	44（32.59）	7（30.43）
否	91（67.41）	16（69.57）
溶栓前NIHSS评分[分，M（Q₁，Q₃）]	6.00（3.00，11.00）	16.00（11.00，20.00）	Z=-4.915	＜0.001
白细胞计数（×10⁹/L， $x ¯$ ±s）	7.98±2.76	7.90±2.68	t=0.128	0.898
白蛋白（g/L， $x ¯$ ±s）	44.20±4.66	40.24±5.43	t=3.672	＜0.001
尿酸（μmol/L， $x ¯$ ±s）	348.89±95.39	305.54±86.36	t=2.041	0.043
HDL-C（mmol/L， $x ¯$ ±s）	1.04±0.32	1.06±0.21	t=-0.261	0.795
LDL-C（mmol/L， $x ¯$ ±s）	2.76±0.89	2.35±0.56	t=2.091	0.038
总胆固醇（mmol/L， $x ¯$ ±s）	4.69±1.12	4.00±0.70	t=2.780	0.006
中性粒细胞计数[×10⁹/L，M（Q₁，Q₃）]	4.66（3.69，6.09）	5.68（3.80，7.42）	Z=-1.003	0.316
淋巴细胞计数[×10⁹/L，M（Q₁，Q₃）]	1.83（1.30，2.55）	1.49（0.80，2.30）	Z=-1.521	0.128
单核细胞计数[×10⁹/L，M（Q₁，Q₃）]	0.41（0.31，0.53）	0.36（0.32，0.46）	Z=-1.642	0.100
红细胞计数[×10¹²/L，M（Q₁，Q₃）]	140.00（128.00，150.00）	135.50（117.00，152.00）	Z=-1.287	0.198
血小板计数[×10⁹/L，M（Q₁，Q₃）]	181.50（156.00，224.00）	179.50（167.00，218.00）	Z=-0.690	0.490
ALT[U/L，M（Q₁，Q₃）]	18.00（14.00，26.00）	16.50（13.00，21.00）	Z=-1.599	0.110
AST[U/L，M（Q₁，Q₃）]	22.00（18.00，28.30）	19.00（15.00，24.80）	Z=-2.096	0.036
DBIL[μmol/L，M（Q₁，Q₃）]	3.20（2.10，4.60）	4.20（2.90，5.60）	Z=-2.695	0.007
血肌酐[μmol/L，M（Q₁，Q₃）]	69.50（57.00，86.80）	69.00（60.00，80.00）	Z=-0.227	0.821
尿素氮[mmol/L，M（Q₁，Q₃）]	6.15（5.00，7.40）	5.70（4.40，7.20）	Z=-1.423	0.155
血糖[mmol/L，M（Q₁，Q₃）]	7.32（6.22，9.86）	7.25（6.30，13.64）	Z=-0.560	0.575
甘油三酯[mmol/L，M（Q₁，Q₃）]	1.56（1.13，2.36）	1.40（0.74，1.83）	Z=-1.681	0.093
SHR[M（Q₁，Q₃）]	1.02（0.89，1.18）	1.19（1.02，1.46）	Z=-2.576	0.010

项目	β值	SE值	Wald χ²值	OR值（95%CI）	P值
溶栓前NIHSS评分	0.173	0.039	19.553	1.189（1.101~1.283）	＜0.001
白蛋白	-0.186	0.052	12.583	0.830（0.749~0.920）	＜0.001
尿酸	-0.006	0.003	3.996	0.994（0.989~1.000）	0.046
LDL-C	-0.664	0.324	4.200	0.515（0.273~0.971）	0.040
总胆固醇	-0.761	0.278	7.027	0.467（0.266~0.820）	0.008
AST	-0.044	0.028	2.444	0.957（0.906~1.011）	0.118
DBIL	0.394	0.128	9.477	1.483（1.154~1.906）	0.002
SHR	1.645	0.746	4.868	5.184（1.202~22.360）	0.027

项目	β值	SE值	Wald χ²值	OR值（95%CI）	P值
模型1	1.645	0.746	4.868	5.184（1.202~22.360）	＜0.001
模型2	1.685	0.757	4.723	5.181（1.175~22.839）	0.030
模型3	3.112	1.477	4.440	22.455（1.243~405.789）	0.035

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