Stress Hyperglycaemia Ratio

Adding SHR to a comprehensive basic clinical model produced a significant and measurable improvement in predictive accuracy for 360-day mortality. SHR is the superior and more actionable index for risk stratification in critically ill patients, and should be prioritised over HGI for acute risk stratification. The linear SHR-mortality relationship found here contrasts with a prior study reporting a U-shaped relationship, likely due to more comprehensive covariate adjustment in the present analysis. SHAP analysis confirmed higher SHR was among the most influential features driving increased predicted mortality risk across all three time horizons in the XGBoost model. LASSO regression selected SHR as one of 11 independent predictors for 360-day mortality, confirming its independent predictive value. SHR measures acute glucose elevation relative to each patient's chronic glycaemic baseline, making it more precise than raw admission glucose alone. RCS analysis confirmed a strictly linear dose-response relationship between SHR and 360-day mortality, with risk increasing monotonically and not plateauing. Higher SHR was consistently and significantly associated with increased mortality ac…