{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T02:23:49Z","timestamp":1787538229487,"version":"build-2736575974"},"reference-count":48,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Post\u2010operative delirium is a serious neurocognitive complication of cardiac surgery. The stress hyperglycaemia ratio (SHR), which adjusts acute glucose levels to baseline glycaemia using glycated haemoglobin, has demonstrated superior prognostic value in critical care; however, its association with delirium remains under\u2010investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study's primary aim was to investigate the association between the SHR and post\u2010operative delirium. The secondary aim was to develop machine\u2010learning models for early risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study analysed 8346 adult patients from the Medical Information Mart for Intensive Care IV database. The SHR was calculated using the peak glucose level within the first 24\u2009h after intensive care unit admission. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit. Multivariable Cox regression and restricted cubic splines evaluated associations, while six machine\u2010learning models were constructed using Boruta\u2010selected features.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Delirium incidence was significantly higher in the high\u2010ratio group than in the low\u2010ratio group (18% vs 11%;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;\u20090.001). After multivariable adjustment, each one\u2010unit increase in the ratio was associated with a 60% increased delirium risk (hazard ratio, 1.60; 95% confidence interval, 1.29\u20131.99). A high ratio independently predicted delirium (hazard ratio, 1.54; 95% confidence interval, 1.31\u20131.82), with restricted cubic splines confirming a linear dose\u2013response relationship (\n                      <jats:italic>P<\/jats:italic>\n                      for non\u2010linearity\u2009=\u20090.203). The support vector machine model achieved the best discriminative performance (area under the curve\u2009=\u20090.8042).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An elevated SHR is an independent risk factor for post\u2010operative delirium. These machine\u2010learning models may facilitate timely perioperative risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/imj.70611","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T01:50:56Z","timestamp":1787536256000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stress hyperglycaemia ratio and post\u2010operative delirium after cardiac surgery: a retrospective cohort study of the\n                    <scp>MIMIC<\/scp>\n                    \u2010\n                    <scp>IV<\/scp>\n                    database"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3816-9618","authenticated-orcid":false,"given":"Duolikun","family":"Mutailifu","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery The First Affiliated Hospital of Xinjiang Medical University  Urumqi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7504-795X","authenticated-orcid":false,"given":"Abudousaimi","family":"Aini","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery The First Affiliated Hospital of Xinjiang Medical University  Urumqi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9750-0244","authenticated-orcid":false,"given":"Malike","family":"Mutailipu","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery The First Affiliated Hospital of Xinjiang Medical University  Urumqi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4108-5579","authenticated-orcid":false,"given":"Wenzhe","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit The First Affiliated Hospital of Xinjiang Medical University  Urumqi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0937-8363","authenticated-orcid":false,"given":"Abudunaibi","family":"Maimaitiaili","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery The First Affiliated Hospital of Xinjiang Medical University  Urumqi China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,23]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1016\/j.athoracsur.2025.03.011","article-title":"The Society of Thoracic Surgeons adult cardiac surgery database: 2024 update on National Trends and outcomes","volume":"119","author":"Iribarne A","year":"2025","journal-title":"Ann Thorac Surg"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","DOI":"10.3390\/medsci13030128","article-title":"Optimizing recovery in cardiac surgery: a narrative review of enhanced recovery after surgery protocols 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