{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T09:44:26Z","timestamp":1774518266894,"version":"3.50.1"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T00:00:00Z","timestamp":1772841600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"Xiaoshan District Science and Technology Plan Guidance Project","award":["Plan No.2022335"],"award-info":[{"award-number":["Plan No.2022335"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"DOI":"10.1186\/s12883-026-04795-8","type":"journal-article","created":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T10:45:44Z","timestamp":1772880344000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of stress hyperglycemia ratio with the incidence of delirium in critically ill patients: a retrospective cohort study with exploratory machine-learning analyses"],"prefix":"10.1186","volume":"26","author":[{"given":"Yuzeng","family":"Xu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyong","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenying","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shengjie","family":"Yao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lifeng","family":"Ni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,7]]},"reference":[{"issue":"7","key":"4795_CR1","doi-asserted-by":"publisher","first-page":"ITC49","DOI":"10.7326\/AITC202010060","volume":"173","author":"M Mattison","year":"2020","unstructured":"Mattison M, Delirium. Ann Intern Med. 2020;173(7):ITC49\u201364.","journal-title":"Ann Intern Med"},{"issue":"5\u20136","key":"4795_CR2","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1007\/s10354-021-00904-z","volume":"172","author":"B Iglseder","year":"2022","unstructured":"Iglseder B, Fr\u00fchwald T, Jagsch C. Delirium in geriatric patients. Wien Med Wochenschr. 2022;172(5\u20136):114\u201321.","journal-title":"Wien Med Wochenschr"},{"key":"4795_CR3","doi-asserted-by":"crossref","unstructured":"Liu SB, Wu HY, Duan ML et al. Delirium in the ICU: how much do we know? A narrative review. Ann Med. 2024;56(1): 240507 2.","DOI":"10.1080\/07853890.2024.2405072"},{"key":"4795_CR4","doi-asserted-by":"crossref","unstructured":"Lagonigro E, Pansini A, Mone P, Guerra G, Komici K, Fantini C. The Role of Stress Hyperglycemia on Delirium Onset. J Clin Med. 2025;14(2):407.","DOI":"10.3390\/jcm14020407"},{"issue":"1","key":"4795_CR5","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1186\/s40001-024-02129-3","volume":"29","author":"P Yao","year":"2024","unstructured":"Yao P, Wu L, Yao H, Shen W, Hu P. Acute hyperglycemia exacerbates neuroinflammation and cognitive impairment in sepsis-associated encephalopathy by mediating the ChREBP\/HIF-1\u03b1 pathway. Eur J Med Res. 2024;29(1):546.","journal-title":"Eur J Med Res"},{"issue":"10","key":"4795_CR6","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.23736\/S0375-9393.18.12400-X","volume":"84","author":"J Hermanides","year":"2018","unstructured":"Hermanides J, Qeva E, Preckel B, Bilotta F. Perioperative hyperglycemia and neurocognitive outcome after surgery: a systematic review. Minerva Anestesiol. 2018;84(10):1178\u201388.","journal-title":"Minerva Anestesiol"},{"issue":"4","key":"4795_CR7","doi-asserted-by":"publisher","first-page":"932","DOI":"10.3390\/jcm13040932","volume":"13","author":"AR Oh","year":"2024","unstructured":"Oh AR, Lee DY, Lee S, et al. Association between Preoperative Glucose Dysregulation and Delirium after Non-Cardiac Surgery. J Clin Med. 2024;13(4):932.","journal-title":"J Clin Med"},{"issue":"12","key":"4795_CR8","doi-asserted-by":"publisher","first-page":"4490","DOI":"10.1210\/jc.2015-2660","volume":"100","author":"GW Roberts","year":"2015","unstructured":"Roberts GW, Quinn SJ, Valentine N, et al. Relative Hyperglycemia, a Marker of Critical Illness: Introducing the Stress Hyperglycemia Ratio. J Clin Endocrinol Metab. 2015;100(12):4490\u20137.","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"4795_CR9","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1186\/s12933-023-02012-1","volume":"22","author":"J Liu","year":"2023","unstructured":"Liu J, Zhou Y, Huang H, et al. Impact of stress hyperglycemia ratio on mortality in patients with critical acute myocardial infarction: insight from the American MIMIC-IV and the Chinese CIN-II study. Cardiovasc Diabetol. 2023;22(1):281.","journal-title":"Cardiovasc Diabetol"},{"issue":"1","key":"4795_CR10","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1186\/s12933-024-02265-4","volume":"23","author":"F Yan","year":"2024","unstructured":"Yan F, Chen X, Quan X, Wang L, Wei X, Zhu J. Association between the stress hyperglycemia ratio and 28-day all-cause mortality in critically ill patients with sepsis: a retrospective cohort study and predictive model establishment based on machine learning. Cardiovasc Diabetol. 2024;23(1):163.","journal-title":"Cardiovasc Diabetol"},{"issue":"7","key":"4795_CR11","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1007\/s00592-024-02259-4","volume":"61","author":"H Pan","year":"2024","unstructured":"Pan H, Xiong Y, Huang Y, Zhao J, Wan H. Association between stress hyperglycemia ratio with short-term and long-term mortality in critically ill patients with ischemic stroke. Acta Diabetol. 2024;61(7):859\u201368.","journal-title":"Acta Diabetol"},{"issue":"1","key":"4795_CR12","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1186\/s12933-024-02454-1","volume":"23","author":"H Esdaile","year":"2024","unstructured":"Esdaile H, Khan S, Mayet J, Oliver N, Reddy M, Shah A. The association between the stress hyperglycaemia ratio and mortality in cardiovascular disease: a meta-analysis and systematic review. Cardiovasc Diabetol. 2024;23(1):412.","journal-title":"Cardiovasc Diabetol"},{"issue":"4","key":"4795_CR13","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1111\/wvn.12462","volume":"17","author":"MH Ho","year":"2020","unstructured":"Ho MH, Montgomery A, Traynor V, et al. Diagnostic Performance of Delirium Assessment Tools in Critically Ill Patients: A Systematic Review and Meta-Analysis. Worldviews Evid Based Nurs. 2020;17(4):301\u201310.","journal-title":"Worldviews Evid Based Nurs"},{"issue":"1","key":"4795_CR14","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s12933-025-02577-z","volume":"24","author":"XH Li","year":"2025","unstructured":"Li XH, Yang XL, Dong BB, Liu Q. Predicting 28-day all-cause mortality in patients admitted to intensive care units with pre-existing chronic heart failure using the stress hyperglycemia ratio: a machine learning-driven retrospective cohort analysis. Cardiovasc Diabetol. 2025;24(1):10.","journal-title":"Cardiovasc Diabetol"},{"issue":"22","key":"4795_CR15","doi-asserted-by":"publisher","first-page":"e26156","DOI":"10.1097\/MD.0000000000026156","volume":"100","author":"Z Chu","year":"2021","unstructured":"Chu Z, Wu Y, Dai X, Zhang C, He Q. The risk factors of postoperative delirium in general anesthesia patients with hip fracture: Attention needed. Med (Baltim). 2021;100(22):e26156.","journal-title":"Med (Baltim)"},{"key":"4795_CR16","doi-asserted-by":"publisher","first-page":"941048","DOI":"10.3389\/fpsyt.2022.941048","volume":"13","author":"S Liu","year":"2022","unstructured":"Liu S, Xv L, Wu X, et al. Potential value of preoperative fasting blood glucose levels in the identification of postoperative delirium in non-diabetic older patients undergoing total hip replacement: The perioperative neurocognitive disorder and biomarker lifestyle study. Front Psychiatry. 2022;13:941048.","journal-title":"Front Psychiatry"},{"issue":"1","key":"4795_CR17","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1186\/s12877-022-02935-6","volume":"22","author":"Q Song","year":"2022","unstructured":"Song Q, Dai M, Zhao Y, Lin T, Huang L, Yue J. Association between stress hyperglycemia ratio and delirium in older hospitalized patients: a cohort study. BMC Geriatr. 2022;22(1):277.","journal-title":"BMC Geriatr"},{"issue":"1","key":"4795_CR18","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1186\/s12933-023-01908-2","volume":"22","author":"Q Zhou","year":"2023","unstructured":"Zhou Q, Yang J, Wang W, Shao C, Hua X, Tang YD. The impact of the stress hyperglycemia ratio on mortality and rehospitalization rate in patients with acute decompensated heart failure and diabetes. Cardiovasc Diabetol. 2023;22(1):189.","journal-title":"Cardiovasc Diabetol"},{"issue":"1","key":"4795_CR19","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1186\/s12933-025-02682-z","volume":"24","author":"Z Li","year":"2025","unstructured":"Li Z, Chen R, Zeng Z, et al. Association of stress hyperglycemia ratio with short-term and long-term prognosis in patients undergoing coronary artery bypass grafting across different glucose metabolism states: a large-scale cohort study. Cardiovasc Diabetol. 2025;24(1):179.","journal-title":"Cardiovasc Diabetol"},{"issue":"1","key":"4795_CR20","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1186\/s12933-022-01728-w","volume":"21","author":"Y Zhou","year":"2022","unstructured":"Zhou Y, Liu L, Huang H, et al. Stress hyperglycemia ratio and in-hospital prognosis in non-surgical patients with heart failure and type 2 diabetes. Cardiovasc Diabetol. 2022;21(1):290.","journal-title":"Cardiovasc Diabetol"},{"issue":"4","key":"4795_CR21","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1186\/cc9100","volume":"14","author":"MR Losser","year":"2010","unstructured":"Losser MR, Damoisel C, Payen D. Bench-to-bedside review: Glucose and stress conditions in the intensive care unit. Crit Care. 2010;14(4):231.","journal-title":"Crit Care"},{"issue":"1","key":"4795_CR22","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1186\/s12933-025-02751-3","volume":"24","author":"G Song","year":"2025","unstructured":"Song G, Liu X, Lu Z, et al. Relationship between stress hyperglycaemic ratio (SHR) and critical illness: a systematic review. Cardiovasc Diabetol. 2025;24(1):188.","journal-title":"Cardiovasc Diabetol"},{"issue":"5","key":"4795_CR23","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1111\/acps.13489","volume":"147","author":"E Klimiec-Moskal","year":"2023","unstructured":"Klimiec-Moskal E, Slowik A, Dziedzic T. Serum C-reactive protein adds predictive information for post-stroke delirium: The PROPOLIS study. Acta Psychiatr Scand. 2023;147(5):536\u201342.","journal-title":"Acta Psychiatr Scand"},{"issue":"1","key":"4795_CR24","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1186\/s13018-024-04699-8","volume":"19","author":"X Yan","year":"2024","unstructured":"Yan X, Huang J, Chen X, Lin M. Association between increased systemic immune-inflammation index and postoperative delirium in older intertrochanteric fracture patients. J Orthop Surg Res. 2024;19(1):219.","journal-title":"J Orthop Surg Res"},{"issue":"2","key":"4795_CR25","doi-asserted-by":"publisher","first-page":"e13543","DOI":"10.1111\/acel.13543","volume":"21","author":"XY Zhou","year":"2022","unstructured":"Zhou XY, Ying CJ, Hu B, et al. The receptor for advanced glycation end products aggravates cognitive deficits in type 2 diabetes by binding the C-terminal AAs 2\u20135 to mitogen-activated protein kinase kinase 3 (MKK3) and facilitating assembly of the MEKK3-MKK3-p38 module. Aging Cell. 2022;21(2):e13543.","journal-title":"Aging Cell"},{"issue":"1","key":"4795_CR26","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1093\/brain\/awae229","volume":"148","author":"S Samanta","year":"2025","unstructured":"Samanta S, Akhter F, Xue R, et al. Synaptic mitochondria glycation contributes to mitochondrial stress and cognitive dysfunction. Brain. 2025;148(1):262\u201375.","journal-title":"Brain"},{"key":"4795_CR27","doi-asserted-by":"crossref","unstructured":"Yonamine CY, Passarelli M, Suemoto CK, et al. Postmortem Brains from Subjects with Diabetes Mellitus Display Reduced GLUT4 Expression and Soma Area in Hippocampal Neurons: Potential Involvement of Inflammation. Cells. 2023;12(9):1250.","DOI":"10.3390\/cells12091250"},{"key":"4795_CR28","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez P, Lozano P, Ros G, Solano F. Hyperglycemia and Oxidative Stress: An Integral, Updated and Critical Overview of Their Metabolic Interconnections. Int J Mol Sci. 2023;24(11):9352.","DOI":"10.3390\/ijms24119352"},{"issue":"3","key":"4795_CR29","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1161\/ATVBAHA.124.321719","volume":"45","author":"X Wang","year":"2025","unstructured":"Wang X, Kang X, Li B, Chen C, Chen L, Liu D. High Glucose Treatment Induces Nuclei Aggregation of Microvascular Endothelial Cells via the foxo1a-klf2a Pathway. Arterioscler Thromb Vasc Biol. 2025;45(3):398\u2013411.","journal-title":"Arterioscler Thromb Vasc Biol"},{"issue":"1","key":"4795_CR30","doi-asserted-by":"publisher","first-page":"2350821","DOI":"10.1080\/21688370.2024.2350821","volume":"13","author":"A Hashmat","year":"2025","unstructured":"Hashmat A, Ya J, Kadir R, Alwjwaj M, Bayraktutan U. Hyperglycaemia perturbs blood-brain barrier integrity through its effects on endothelial cell characteristics and function. Tissue Barriers. 2025;13(1):2350821.","journal-title":"Tissue Barriers"},{"key":"4795_CR31","doi-asserted-by":"publisher","first-page":"1323407","DOI":"10.3389\/fendo.2024.1323407","volume":"15","author":"X Liu","year":"2024","unstructured":"Liu X, Li Y, Chen X, et al. Revisiting the mechanisms linking blood glucose to cognitive impairment: new evidence for the potentially important role of klotho. Front Endocrinol (Lausanne). 2024;15:1323407.","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"4","key":"4795_CR32","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1007\/s44254-025-00158-7","volume":"3","author":"X Wang","year":"2025","unstructured":"Wang X, Mi X, Cui Y, et al. Retinal nerve fiber layer thinning as a predictor of delirium in medical and surgical patients: a prospective cohort study. Anesthesiology Perioperative Sci. 2025;3(4):63.","journal-title":"Anesthesiology Perioperative Sci"},{"issue":"9","key":"4795_CR33","doi-asserted-by":"publisher","first-page":"1484","DOI":"10.1097\/CCM.0000000000006324","volume":"52","author":"JS Krinsley","year":"2024","unstructured":"Krinsley JS. Glucose Control in Critically Ill Patients: Is It All Relative? Crit Care Med. 2024;52(9):1484\u20137.","journal-title":"Crit Care Med"},{"issue":"1","key":"4795_CR34","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1186\/s12967-022-03364-0","volume":"20","author":"S Yue","year":"2022","unstructured":"Yue S, Li S, Huang X, et al. Machine learning for predicting acute kidney injury in patients with sepsis. J Transl Med. 2022;20(1):215.","journal-title":"J Transl Med"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-026-04795-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-026-04795-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-026-04795-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T08:31:05Z","timestamp":1774513865000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12883-026-04795-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,7]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4795"],"URL":"https:\/\/doi.org\/10.1186\/s12883-026-04795-8","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,7]]},"assertion":[{"value":"24 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was reviewed and approved by the Ethics Committee of Zhejiang Xiaoshan Hospital (Approval No. 2025010). All procedures were performed in accordance with the ethical standards of the Declaration of Helsinki.The MIMIC-IV database, which de-identifies patient records, has been approved by the institutional ethics review boards of both MIT and the Beth Israel Deaconess Medical Center and is exempt from the requirement for informed consent. The information of all patients was anonymized prior to extraction and data analysis, thereby waiving the requirement for individual patient consent. This study adhered to the principles outlined in the Declaration of Helsinki.Lifeng Ni was authorized to access the database after completing online training and assessments, as evidenced by certification number 65512516.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"188"}}