# Head-to-head comparison of stress hyperglycemia ratio versus triglyceride-glucose index for predicting mortality in heart failure: a retrospective cohort study

## TL;DR

This study compares two blood sugar-related markers to see which better predicts death risk in heart failure patients over different timeframes.

## Contribution

The study provides a direct comparison of SHR and TyG index for mortality prediction in heart failure patients.

## Key findings

- SHR was significantly associated with increased mortality risk at all time points, including 1-year mortality.
- TyG index showed significant associations with mortality at 180, 90, and 30 days but not at 1 year.
- No significant difference in predictive performance was found between SHR and TyG index at any time point.

## Abstract

Heart failure (HF) is a life-threatening clinical syndrome characterized by high incidence and mortality, leading to considerable global health and economic burdens. Stress-induced hyperglycemia ratio (SHR) and triglyceride-glucose (TyG) index, as emerging biomarkers reflecting glucose metabolism, are closely associated with poor prognosis in many diseases. However, it remains unclear which of these two indicators possesses superior association and predictive value for prognosis in critically ill patients with HF.

A retrospective cohort study was conducted on critically ill HF patients, enrolled from the Medical Information Mart for Intensive Care IV (MIMIC-IV) version 3.1. The primary outcome was 180-day mortality, with 1-year (365-day), 90-day, and 30-day mortality as secondary outcomes. Baseline characteristics were compared between survivors and non-survivors. Cox regression, restricted cubic spline (RCS), Kaplan-Meier (K-M), and subgroup analyses were used to assess the association of SHR and TyG index with mortality. Discriminative performance of SHR versus TyG index was compared using ROC curves.

A total of 1,063 patients were enrolled. After adjusting for confounders, Cox regression analyses revealed that SHR was significantly associated with an increased risk of 180-day, 365-day, 90-day, and 30-day mortality, with hazard ratios (HRs) of 1.35, 1.26, 1.47, and 1.53, respectively. In contrast, TyG index was only associated with mortality risk at 180, 90, and 30 days (HRs: 1.20, 1.24, and 1.31, respectively), with no significant association observed at 1 year. Moreover, these associations were predominantly linear in nature. However, no statistically significant difference was observed in the predictive performance of SHR and TyG index for mortality at any time points (P>0.05).

SHR and TyG index can be used as potential risk assessment tools for short-term (180-, 90-, and 30-day) mortality risk in critically ill HF patients, nevertheless, SHR is a more applicable and robust metabolic biomarker associated with 1-year mortality.