Abstract: SA-PO0441
Prognostic Value of the Stress Hyperglycemia Ratio for Cardiovascular Events in Patients with Moderate-to-Severe CKD and Heart Failure
Session Information
- CKM: Clinical - Epidemiology and Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Cheng, Hong, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
- Feng, Yiou, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
- Wang, Guoqin, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
- Ye, Nan, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
Background
Stress hyperglycemia ratio (SHR) predicts cardiovascular risk, but its prognostic value in stage 3–5 chronic kidney disease (CKD) with heart failure, especially advanced CKD, remains unclear. This study explored the association between SHR and cardiovascular events in this cohort.
Methods
We retrospectively enrolled hospitalized stage 3–5 CKD patients with heart failure from January 2018 to January 2025, excluding those undergoing regular dialysis. The composite endpoint consisted of major adverse cardiovascular events and heart failure rehospitalization. The optimal SHR cut-off value was determined using ROC curves. Cox regression models and Kaplan–Meier curves were applied to assess the prognostic effect of SHR, while restricted cubic splines were used to explore the dose-response association between SHR and clinical outcomes.
Results
Among the 385 enrolled patients, 161 (41.81%) reached the composite cardiac endpoint, with significantly higher SHR levels in the event group (P=0.026). Using an optimal SHR cut-off of 0.855 (maximum Youden index), patients were divided into high (n=139) and low (n=246) SHR groups; the high SHR group had a notably higher cardiovascular event incidence (log-rank P=0.002). After adjusting for age, gender, hemoglobin, 24-hour urinary total microalbumin, eGFR, hyperkalemia, ejection fraction, coronary heart disease, and acute admission status, elevated SHR remained an independent predictor of the composite endpoint (adjusted HR=1.532, 95%CI: 1.119–2.099, P=0.008). Restricted cubic spline analysis showed a J-shaped association between SHR and endpoint risk (lowest risk at SHR≈0.668): above this inflection point, higher SHR correlated with increased MACE and heart failure rehospitalization risk; below it, a non-significant risk increase was noted, likely due to small sample size and inadequate statistical power.
Conclusion
This study identifies the stress hyperglycemia ratio (SHR) as a key predictor of long-term adverse outcomes in patients with stage 3–5 CKD and heart failure. Restricted cubic spline analysis revealed a J-shaped association (risk nadir at SHR ≈ 0.668), where elevated SHR significantly increased the composite endpoint of MACE and heart failure rehospitalization, confirming high SHR as an independent risk factor.