{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T04:41:08Z","timestamp":1793162468618,"version":"4.5.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical Education Center, Saraburi Hospital","award":["MC012-2566, 2023"],"award-info":[{"award-number":["MC012-2566, 2023"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The stress hyperglycemia ratio (SHR), a newly developed metric, is used to assess adverse outcomes in patients with acute ischemic stroke (AIS). However, the relationship between SHR and fatal outcomes (in-hospital mortality [IHM], malignant cerebral edema [MCE], symptomatic intracerebral hemorrhage [sICH], 3-month mortality, and poor functional outcome) in AIS patients receiving recombinant tissue plasminogen activator (rt-PA) treatment is unclear, and determining the optimal threshold remains incomplete.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>We retrospectively enrolled a total of 345 AIS patients treated with rt-PA during 2015\u20132022 and collected data on various glucose metrics, including different types of SHR, glycemic gap (GG), random plasma glucose (RPG), fasting plasma glucose (FPG), and hemoglobin A1c (HbA1c). SHR and GG were calculated using these equations: SHR1, [FPG]\/[HbA1c]; SHR2, [admission RPG]\/[HbA1c]; SHR3, FPG\/[(1.59 \u00d7 HbA1c)\u22122.59]; SHR4, [admission RPG]\/[(1.59 \u00d7 HbA1c)\u22122.59]; GG, admission RPG \u2212 [(1.59 \u00d7 HbA1c)\u22122.59]. We used multivariable logistic regression analysis (MVLR) to identify the association between different glucose metrics and outcomes while comparing their predictive values.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>SHR1 had the greatest predictive power and a more significant correlation with fatal outcomes than other continuous glucose metrics. The area under the curve of the SHR1 for IHM, MCE, and sICH, 3-month mortality, and poor functional outcome were 0.75, 0.77, 0.77, 0.76, and 0.73, respectively. SHR1 (per 1-point increases) was independently associated with IHM (Odds ratios [ORs] = 5.80; 95% CI [1.96, 17.17]; <jats:italic>p<\/jats:italic> = 0.001), MCE (ORs = 4.73; 95% CI [1.71, 13.04]; <jats:italic>p<\/jats:italic> = 0.003), sICH (ORs = 4.68, 95% CI [1.48\u201314.82]; <jats:italic>p<\/jats:italic> = 0.009), 3-month mortality (ORs = 10.87; 95% CI [3.56, 33.21]; <jats:italic>p<\/jats:italic>&lt;0.001), and 3-month poor functional outcome (ORs = 8.05; 95% CI [2.77, 23.39]; p&lt;0.001) after adjustment in MVLR. In subgroup analysis, elevated SHR1 was associated with fatal outcomes in patients with non-diabetes, SBP\u2265 180 mmHg, and NIHSS &lt;16.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>SHR1 demonstrates an independent association with fatal outcomes in AIS patients treated with rt-PA, exhibiting superior predictive ability over other glucose metrics.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0297809","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T18:33:20Z","timestamp":1706726000000},"page":"e0297809","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["Performance comparison of stress hyperglycemia ratio for predicting fatal outcomes in patients with thrombolyzed acute ischemic stroke"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4563-9222","authenticated-orcid":true,"given":"Sarawut","family":"Krongsut","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7124-6807","authenticated-orcid":true,"given":"Chatchon","family":"Kaewkrasaesin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"issue":"6","key":"pone.0297809.ref001","first-page":"35","article-title":"Can stroke fast track improve quality of life of patients with acute ischemic stroke?","volume":"103","author":"S Tiamkao","year":"2020","journal-title":"J Med Assoc Thail"},{"issue":"1","key":"pone.0297809.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5853\/jos.2014.16.1.1","article-title":"Stroke Epidemiology in Thailand","volume":"16","author":"NC 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Powers","year":"2019","journal-title":"Stroke"},{"issue":"1","key":"pone.0297809.ref014","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1093\/qjmed\/hcaa253","article-title":"Stress hyperglycaemia is associated with poor functional outcomes in patients with acute ischaemic stroke after intravenous thrombolysis","volume":"115","author":"JN Ngiam","year":"2022","journal-title":"QJM"},{"issue":"February","key":"pone.0297809.ref015","first-page":"1","article-title":"Admission Random Blood Glucose, Fasting Blood Glucose, Stress Hyperglycemia Ratio, and Functional Outcomes in Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis","volume":"14","author":"G Chen","year":"2022","journal-title":"Front Aging Neurosci."},{"issue":"2","key":"pone.0297809.ref016","doi-asserted-by":"crossref","first-page":"E115","DOI":"10.1097\/CCM.0000000000004133","article-title":"Relative hyperglycemia is an independent determinant of in-hospital mortality in patients with critical 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