{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T08:40:23Z","timestamp":1785400823289,"version":"3.56.0"},"reference-count":31,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babe\u0219 University of Medicine and Pharmacy, Timi\u0219oara, Romania","award":["5\/4270"],"award-info":[{"award-number":["5\/4270"]}]},{"award":["5\/4270"],"award-info":[{"award-number":["5\/4270"]}],"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Patients with diabetes face increased risks during viral respiratory infections. While chronic glycemic control (HbA1c) is a known risk factor, it may fail to capture acute metabolic failure. This study aimed to evaluate the stress hyperglycemia ratio (SHR) at two time points (admission and 72 h) as a prognostic marker. Methods: We conducted a longitudinal analysis of 430 patients (211 with diabetes and 219 without diabetes) hospitalized with viral respiratory infections. The SHR was calculated at admission (SHR_z1) and at 72 h (SHR_z3). The primary outcome was severe clinical deterioration (defined as oxygen requirement &gt;2\u2013HFNO\/OTI or mortality). Multivariate logistic regression and ROC curve analysis were used to determine independent predictors and clinical cut-off points. Results: In the global multivariable model (N = 430), continuous SHR_z3 emerged as an independent predictor of severe outcome (OR = 1.86, 95% CI 1.09\u20133.20, p = 0.0240) alongside chronic glycemic control (HbA1c: OR = 1.41, p &lt; 0.0001) and age (OR = 1.05, p = 0.0001). After stratification, the independent SHR_z3 effect attenuated below statistical significance in both the non-diabetic (p = 0.6168) and diabetic (p = 0.1954) sub-cohorts, while HbA1c (p = 0.0404) and age (p = 0.0036) remained independent predictors within the diabetic subgroup. An exploratory longitudinal phenotype model classifying patients into Stable Normal, Resolvers, Persistent, and Late Spikers showed the highest in-sample discrimination of all models tested (AUC = 0.797, 95% CI 0.756\u20130.834). Within this model, the Persistent phenotype (SHR \u2265 1.1 sustained at admission and at 72 h) showed a non-significant trend toward higher adjusted odds of severe outcome compared with Stable Normal patients (OR = 1.81, 95% CI 0.91\u20133.60, p = 0.088) and was associated with a significantly longer hospital stay (Kruskal\u2013Wallis p = 0.004 across phenotypes). Conclusions: Persistent stress hyperglycemia at 72 h is an independent predictor of severe outcome in the unstratified cohort after adjustment for chronic glycemic control, age, and other covariates. Within metabolic strata, the SHR_z3 signal attenuates, and long-standing suboptimal glycemic control (HbA1c) and age dominate, particularly among diabetic patients. Longitudinal SHR trajectories may therefore provide complementary, hypothesis-generating prognostic information when combined with chronic baseline markers, although these findings require external validation in independent cohorts before clinical use.<\/jats:p>","DOI":"10.3390\/diagnostics16152310","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T09:11:26Z","timestamp":1784797886000},"page":"2310","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal Stress Hyperglycemia Trajectories and Severe Outcome in Patients Hospitalized for Viral Respiratory Infections: A 72-Hour Phenotyping Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6508-928X","authenticated-orcid":false,"given":"Ana Maria","family":"Mihai","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Victor Babes Clinical Hospital for Infectious Diseases and Pneumology of Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8236-2205","authenticated-orcid":false,"given":"Ovidiu","family":"Rosca","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Victor Babes Clinical Hospital for Infectious Diseases and Pneumology of Timisoara, 300041 Timisoara, Romania"},{"name":"Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7865-9915","authenticated-orcid":false,"given":"Florina","family":"Lucaciu","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Victor Babes Clinical Hospital for Infectious Diseases and Pneumology of Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Herlo","sequence":"additional","affiliation":[{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Victor Babes Clinical Hospital for Infectious Diseases and Pneumology of Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6567-4407","authenticated-orcid":false,"given":"Talida Georgiana","family":"Cut","sequence":"additional","affiliation":[{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Victor Babes Clinical Hospital for Infectious Diseases and Pneumology of Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matilda","family":"Radulescu","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Division of Microbiology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delia Mira","family":"Berceanu-Vaduva","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Division of Microbiology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana-Melinda","family":"Luput-Andrica","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6325-185X","authenticated-orcid":false,"given":"Radu Gheorghe","family":"Dan","sequence":"additional","affiliation":[{"name":"Center for Hepato-Biliary-Pancreatic Surgery, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Department of Surgery I, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andra-Elena","family":"Saizu","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Victor Babes Clinical Hospital for Infectious Diseases and Pneumology of Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea-Cristina","family":"Floruncut","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Victor Babes Clinical Hospital for Infectious Diseases and Pneumology of Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelina-Raluca","family":"Marinescu","sequence":"additional","affiliation":[{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Victor Babes Clinical Hospital for Infectious Diseases and Pneumology of Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9042-9924","authenticated-orcid":false,"given":"Alexandra","family":"Sima","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Department of Diabetes, Nutrition and Metabolic Diseases Clinic, \u201cPius Br\u00eenzeu\u201d Emergency Clinical County University Hospital, 300723 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Pyeritz, R.E. 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