Impact of hemoglobin glycation index and stress hyperglycemia ratio on short-term mortality in critically ill patients with heart failure: a retrospective cohort study using the MIMIC database

Min He; Lingyan Lei; Siyu Ren; Yongqi Lin; Qianghong Zhang; Guoqing Liu; Pengzhan Li; Xueshuang Bei; Liangbo Hu; Yue Wang; Lina Tan; Xiaocong Zeng

doi:10.1016/j.numecd.2026.104814

Impact of hemoglobin glycation index and stress hyperglycemia ratio on short-term mortality in critically ill patients with heart failure: a retrospective cohort study using the MIMIC database

Nutr Metab Cardiovasc Dis. 2026 May 27:104814. doi: 10.1016/j.numecd.2026.104814. Online ahead of print.

Authors

Min He¹, Lingyan Lei², Siyu Ren¹, Yongqi Lin¹, Qianghong Zhang¹, Guoqing Liu¹, Pengzhan Li¹, Xueshuang Bei³, Liangbo Hu¹, Yue Wang¹, Lina Tan¹, Xiaocong Zeng⁴

Affiliations

¹ Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, 530021, China.
² Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, 530021, China; Department of Cardiovascular Medicine, Minzu Hospital of Guangxi Zhuang Autonomous Region, Nanning 530001, Guangxi, China.
³ Guangxi Medical University, Nanning, Guangxi, China.
⁴ Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, 530021, China; Guangxi Key Laboratory Base of Precision Medicine in Cardiocerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, Guangxi, China; School of Basic Medical Sciences, Guangxi Medical University, Nanning, Guangxi, China. Electronic address: aban829@163.com.

PMID: 42250973
DOI: 10.1016/j.numecd.2026.104814

Abstract

Background and aims: To evaluate the prognostic value of the combined assessment of hemoglobin glycation index (HGI) and stress hyperglycemia ratio (SHR) for short-term mortality in critically ill patients with heart failure (HF).

Methods and results: ICU data on HF patients were retrospectively retrieved from the MIMIC-III and IV databases between 2001 and 2022. SHR and HGI were calculated at admission and stratified into tertiles. The endpoint was in-hospital and 90-day mortality. Logistic and Cox models evaluated associations between SHR, HGI, and their combination with mortality in both diabetic and non-diabetic patients. Exploratory interpretable machine learning prognostic models were developed to evaluate predictive performance. A total of 1573 HF patients were included. In-hospital and 90-day mortality rates were 14.1% and 24.3%, respectively. High SHR was independently associated with increased in-hospital mortality (OR: 2.01, 95% CI: 1.31-3.09) and 90-day mortality (HR: 1.54, 95% CI: 1.18-2.00). Higher HGI was associated with a reduced risk of in-hospital mortality (OR: 0.88, 95% CI: 0.78-0.99) and 90-day mortality (HR: 0.91, 95% CI: 0.84-0.98). High SHR and low HGI had the highest mortality risk for both in-hospital mortality (OR: 1.90, 95% CI: 1.288-2.85) and 90-day mortality (HR: 1.45, 95% CI: 1.13-1.87). The XGBoost model demonstrated optimal predictive accuracy, with an AUROC of 0.810 for in-hospital mortality and 0.808 for 90-day mortality.

Conclusion: High SHR and low HGI are significantly associated with short-term mortality in HF patients, suggesting that their combined assessment may improve short-term prognostic assessment in critically ill patients with HF.

Keywords: Diabetes; Heart failure; Hemoglobin glycation index; Mortality; Stress hyperglycemia ratio.

Copyright © 2026 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.