{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:27:13Z","timestamp":1792099633208,"version":"4.4.0"},"reference-count":38,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T00:00:00Z","timestamp":1752451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Natural Science Foundation of Sichuan Province","award":["2024NSFC0685"],"award-info":[{"award-number":["2024NSFC0685"]}]},{"name":"National Natural Science Foundation of Sichuan Province","award":["2023ZD04"],"award-info":[{"award-number":["2023ZD04"]}]},{"name":"Project of Sichuan Provincial Administration of Traditional Chinese Medicine Innovation Research Team","award":["2024NSFC0685"],"award-info":[{"award-number":["2024NSFC0685"]}]},{"name":"Project of Sichuan Provincial Administration of Traditional Chinese Medicine Innovation Research Team","award":["2023ZD04"],"award-info":[{"award-number":["2023ZD04"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The stress hyperglycemia ratio (SHR) has emerged as a promising biomarker for assessing stress-induced hyperglycemia (SH) but has not been evaluated in patients with acute pancreatitis (AP). This study investigates the role of the SHR in predicting adverse clinical outcomes in patients with AP. Methods: Adult patients with AP who were admitted within 72 h of the onset of abdominal pain were screened in the database. Eligible patients with glycated hemoglobin (HbA1c) and blood glucose were analyzed. The SHR was calculated using admission blood glucose and HbA1c levels. Patients were categorized into four groups: SHR1 (\u22641.03), SHR2 (1.04\u20131.25), SHR3 (1.26\u20131.46), and SHR4 (\u22651.47). The primary outcome was persistent organ failure (POF). The secondary outcomes included acute peripancreatic fluid collection (APFC) and high-dependency unit\/intensive care unit (HDU\/ICU) admission. Restricted cubic spline (RCS) analysis was used to assess nonlinear associations and identify SHR threshold values. Univariable and multivariable logistic regression models were used to adjust for potential confounders and evaluate the relationship between the SHR and clinical outcomes. Results: A total of 486 patients with AP were included in this study, comprising 85 with POF and 401 without POF. SHR levels and severity were significantly correlated, with the highest quartile in the greatest proportion of severe acute pancreatitis (SAP). Higher SHR levels were significantly associated with an increased risk of POF, APFC, and HDU\/ICU admission. RCS analysis revealed a nonlinear relationship between the SHR and APFC (p = 0.009). Based on the RCS and quartile analysis, SHR &gt; 1.25 was identified as the threshold for increased risk. After adjusting for confounders, SHR &gt; 1.25 remained independently associated with higher risks of POF (OR: 2.49, 95% CI: 1.39\u20134.46, p = 0.002), APFC (OR: 2.85, 95% CI: 1.92\u20134.24, p &lt; 0.001), and ICU admission (OR: 1.74, 95% CI: 1.12\u20132.69, p = 0.013). Conclusions: The SHR is independently associated with adverse clinical outcomes in AP, including POF, APFC, and HDU\/ICU admission. These findings suggest that the SHR may serve as a valuable biomarker for risk stratification and early intervention in AP management.<\/jats:p>","DOI":"10.3390\/jcm14144970","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T10:55:41Z","timestamp":1752490541000},"page":"4970","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Stress Hyperglycemia Ratio as a Predictor of Clinical Outcomes in Acute Pancreatitis: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Ping","family":"Zhu","sequence":"first","affiliation":[{"name":"West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinwei","family":"Wang","sequence":"additional","affiliation":[{"name":"West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Hu","sequence":"additional","affiliation":[{"name":"West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxin","family":"Zhang","sequence":"additional","affiliation":[{"name":"West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziqi","family":"Lin","sequence":"additional","affiliation":[{"name":"West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Jin","sequence":"additional","affiliation":[{"name":"West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Li","sequence":"additional","affiliation":[{"name":"West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Shi","sequence":"additional","affiliation":[{"name":"West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinmin","family":"Yang","sequence":"additional","affiliation":[{"name":"West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8659-322X","authenticated-orcid":false,"given":"Wei","family":"Huang","sequence":"additional","affiliation":[{"name":"West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Xia","sequence":"additional","affiliation":[{"name":"West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihui","family":"Deng","sequence":"additional","affiliation":[{"name":"West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1001\/jama.2020.20317","article-title":"Acute Pancreatitis: A Review","volume":"325","author":"Mederos","year":"2021","journal-title":"JAMA-J. Am. Med. Assoc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S2468-1253(16)30004-8","article-title":"Global Incidence and Mortality of Pancreatic Diseases: A Systematic Review, Meta-Analysis, and Meta-Regression of Population-Based Cohort Studies","volume":"1","author":"Xiao","year":"2016","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1053\/j.gastro.2021.09.043","article-title":"Global Incidence of Acute Pancreatitis Is Increasing over Time: A Systematic Review and Meta-Analysis","volume":"162","author":"Iannuzzi","year":"2022","journal-title":"Gastroenterology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Classification of Acute Pancreatitis\u20142012: Revision of the Atlanta Classification and Definitions by International Consensus","volume":"62","author":"Banks","year":"2013","journal-title":"Gut"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1016\/S0140-6736(20)31310-6","article-title":"Acute Pancreatitis","volume":"396","author":"Boxhoorn","year":"2020","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1798","DOI":"10.1016\/S0140-6736(09)60553-5","article-title":"Stress Hyperglycaemia","volume":"373","author":"Dungan","year":"2009","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1007\/s10620-021-06982-8","article-title":"Stress Hyperglycemia Is Independently Associated with Persistent Organ Failure in Acute Pancreatitis","volume":"67","author":"Yang","year":"2022","journal-title":"Dig. Dis. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"123469","DOI":"10.1016\/j.lfs.2025.123469","article-title":"Stress Hyperglycemia in Acute Pancreatitis: From Mechanisms to Prognostic Implications","volume":"365","author":"Guan","year":"2025","journal-title":"Life Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4106","DOI":"10.1038\/s41598-023-30608-w","article-title":"Predictive Value of Hyperglycemia on Infection in Critically Ill Patients with Acute Pancreatitis","volume":"13","author":"Jin","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1007\/s11739-023-03524-0","article-title":"Impact of Stress Hyperglycemia on Long-Term Prognosis in Acute Pancreatitis without Diabetes","volume":"19","author":"Zhang","year":"2024","journal-title":"Intern. Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"998499","DOI":"10.3389\/fendo.2022.998499","article-title":"Impact of Admission and Early Persistent Stress Hyperglycaemia on Clinical Outcomes in Acute Pancreatitis","volume":"13","author":"Yang","year":"2022","journal-title":"Front. Endocrinol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1097\/MPA.0000000000002074","article-title":"Assessing the Pathophysiology of Hyperglycemia in the Diabetes RElated to Acute Pancreatitis and Its Mechanisms Study: From the Type 1 Diabetes in Acute Pancreatitis Consortium","volume":"51","author":"Dungan","year":"2022","journal-title":"Pancreas"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4490","DOI":"10.1210\/jc.2015-2660","article-title":"Relative Hyperglycemia, a Marker of Critical Illness: Introducing the Stress Hyperglycemia Ratio","volume":"100","author":"Roberts","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s12933-023-01742-6","article-title":"Association of Stress Hyperglycemia Ratio and Poor Long-Term Prognosis in Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries","volume":"22","author":"Abdu","year":"2023","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1186\/s12933-024-02271-6","article-title":"Association of Stress Hyperglycemia Ratio with Left Ventricular Function and Microvascular Obstruction in Patients with ST-Segment Elevation Myocardial Infarction: A 3.0 T Cardiac Magnetic Resonance Study","volume":"23","author":"Bo","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s12933-024-02160-y","article-title":"Prognostic Effect of Stress Hyperglycemia Ratio on Patients with Severe Aortic Stenosis Receiving Transcatheter Aortic Valve Replacement: A Prospective Cohort Study","volume":"23","author":"Hu","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s12933-023-02105-x","article-title":"Relationship between Stress Hyperglycemia Ratio and Acute Kidney Injury in Patients with Congestive Heart Failure","volume":"23","author":"Li","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1186\/s12933-023-02061-6","article-title":"Impact of Stress Hyperglycemia Ratio, Derived from Glycated Albumin or Hemoglobin A1c, on Mortality among ST-Segment Elevation Myocardial Infarction Patients","volume":"22","author":"Liao","year":"2023","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s12933-023-01799-3","article-title":"Positive Association between Stress Hyperglycemia Ratio and Pulmonary Infection in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention","volume":"22","author":"Lin","year":"2023","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1186\/s12933-023-02012-1","article-title":"Impact of Stress Hyperglycemia Ratio on Mortality in Patients with Critical Acute Myocardial Infarction: Insight from American MIMIC-IV and the Chinese CIN-II Study","volume":"22","author":"Liu","year":"2023","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1094353","DOI":"10.3389\/fendo.2023.1094353","article-title":"Impacts of Stress Hyperglycemia Ratio on Early Neurological Deterioration and Functional Outcome after Endovascular Treatment in Patients with Acute Ischemic Stroke","volume":"14","author":"Dai","year":"2023","journal-title":"Front. Endocrinol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e0297809","DOI":"10.1371\/journal.pone.0297809","article-title":"Performance Comparison of Stress Hyperglycemia Ratio for Predicting Fatal Outcomes in Patients with Thrombolyzed Acute Ischemic Stroke","volume":"19","author":"Krongsut","year":"2024","journal-title":"PLoS ONE"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1186\/s12883-024-03795-w","article-title":"Association between Stress Hyperglycemia Ratio and Functional Outcomes in Patients with Acute Ischemic Stroke","volume":"24","author":"Xiao","year":"2024","journal-title":"BMC Neurol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1463814","DOI":"10.3389\/fneur.2024.1463814","article-title":"Premorbid Frailty, Stress Hyperglycemia Ratio, and Functional Outcome in Patients with Acute Ischemic Stroke","volume":"15","author":"Zedde","year":"2024","journal-title":"Front. Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1007\/s15010-024-02264-3","article-title":"Association of Stress Hyperglycemia Ratio and Mortality in Patients with Sepsis: Results from 13,199 Patients","volume":"52","author":"Li","year":"2024","journal-title":"Infection"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"7939","DOI":"10.2147\/JIR.S476898","article-title":"Association of Stress Hyperglycemia Ratio and In-Hospital Mortality in Patients with Sepsis: A Two Center Retrospective Cohort Study","volume":"17","author":"Ma","year":"2024","journal-title":"J. Inflamm. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1186\/s12879-024-10179-5","article-title":"The Association between Stress Hyperglycemia Ratio and Clinical Outcomes in Patients with Sepsis-Associated Acute Kidney Injury: A Secondary Analysis of the MIMIC-IV Database","volume":"24","author":"Zhou","year":"2024","journal-title":"BMC Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1111\/1753-0407.13398","article-title":"Stress Hyperglycemia Ratio Is Associated with Systemic Inflammation and Clinical Outcomes in Diabetic Inpatients with Pneumonia on Admission","volume":"15","author":"Liu","year":"2023","journal-title":"J. Diabetes"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.pan.2021.12.001","article-title":"Growth Differentiation Factor 15 Is an Early Predictor for Persistent Organ Failure and Mortality in Acute Pancreatitis","volume":"22","author":"Tan","year":"2022","journal-title":"Pancreatology"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Zhang, S., Chen, Z., Hu, C., Zhu, P., Jin, T., Li, L., Lin, Z., Shi, N., Zhang, X., and Xia, Q. (2024). The Clinical Characteristics and Outcomes of Acute Pancreatitis Are Different in Elderly Patients: A Single-Center Study over a 6-Year Period. J. Clin. Med., 13.","DOI":"10.3390\/jcm13164829"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1097\/00003246-199510000-00007","article-title":"Multiple Organ Dysfunction Score: A Reliable Descriptor of a Complex Clinical Outcome","volume":"23","author":"Marshall","year":"1995","journal-title":"Crit. Care Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.2337\/dc08-0545","article-title":"Translating the A1C Assay into Estimated Average Glucose Values","volume":"31","author":"Nathan","year":"2008","journal-title":"Diabetes Care"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee (2024). 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes\u20142025. Diabetes Care, 48, S27\u2013S49.","DOI":"10.2337\/dc25-S002"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s12933-024-02172-8","article-title":"The Prognostic Value of the Stress Hyperglycemia Ratio for All-Cause and Cardiovascular Mortality in Patients with Diabetes or Prediabetes: Insights from NHANES 2005\u20132018","volume":"23","author":"Ding","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s12933-024-02146-w","article-title":"Simultaneous Assessment of Stress Hyperglycemia Ratio and Glycemic Variability to Predict Mortality in Patients with Coronary Artery Disease: A Retrospective Cohort Study from the MIMIC-IV Database","volume":"23","author":"He","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1097\/MPA.0000000000002216","article-title":"Deep Learning Models for Severity Prediction of Acute Pancreatitis in the Early Phase from Abdominal Nonenhanced Computed Tomography Images","volume":"52","author":"Chen","year":"2023","journal-title":"Pancreas"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.gtc.2024.09.001","article-title":"Organ Failure and Prediction of Severity in Acute Pancreatitis","volume":"54","author":"Mahapatra","year":"2025","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/MCG.0000000000001843","article-title":"Early Predictive Value of Different Indicators for Persistent Organ Failure in Acute Pancreatitis: A Systematic Review and Network Meta-Analysis","volume":"58","author":"Wang","year":"2024","journal-title":"J. Clin. Gastroenterol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/4970\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:09:34Z","timestamp":1760033374000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/4970"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,14]]},"references-count":38,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14144970"],"URL":"https:\/\/doi.org\/10.3390\/jcm14144970","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,14]]}}}