---
title: "Stress hyperglycemia ratio predicts major complications after cardiac surgery with cardiopulmonary"
id: "pubmed-42900380"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42900380"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42900380/"
doi: "10.1007/s00540-026-03921-7"
published_at: "2026-10-20T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Stress hyperglycemia ratio predicts major complications after cardiac surgery with cardiopulmonary
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42900380
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42900380/)
- **DOI:** [10.1007/s00540-026-03921-7](https://doi.org/10.1007%2Fs00540-026-03921-7)
- **Published At:** 2026-10-20T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This single-center retrospective cohort included 731 surgical episodes from 709 adults who underwent **cardiac surgery** with **cardiopulmonary bypass**. - Investigators calculated the **stress hyperglycemia ratio (SHR)** as first ICU glucose divided by HbA1c-derived estimated average glucose. - The primary outcome was an unweighted composite: 30-day mortality, stroke, KDIGO stage 3 acute kidney injury, reoperation for bleeding, prolonged mechanical ventilation, and deep sternal wound infection. - The composite occurred in 90 surgical episodes (12.3%). - Multivariable logistic regression adjusted for clinically relevant covariates. - SHR at ICU admission associated with the composite outcome (OR 1.103 per 0.1 increase; 95% CI 1.008–1.208; P = 0.033). - Absolute ICU admission glucose was not significantly associated after adjustment (OR 1.019 per 10 mg/dL; 95% CI 0.946–1.096; P = 0.626). - Authors noted that confidence intervals for SHR included 1.0 in several sensitivity analyses. - The study team concluded that **SHR** warrants prospective evaluation as an early postoperative risk marker after cardiac surgery with cardiopulmonary bypass. - The source did not report detailed perioperative glucose management protocols or HbA1c thresholds used for subgrouping; those details were not provided in the abstract.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Stress hyperglycemia ratio as a marker of major postoperative complications after cardiac surgery with cardiopulmonary bypass [Hiroki Anezaki](https://pubmed.ncbi.nlm.nih.gov/?term=Anezaki+H&cauthor_id=42900380)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42900380/#full-view-affiliation-1 "Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan. anezaki.hiroki@gmail.com."), [Soichiro Mimuro](https://pubmed.ncbi.nlm.nih.gov/?term=Mimuro+S&cauthor_id=42900380)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42900380/#full-view-affiliation-2 "Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan."), [Naoki Washiyama](https://pubmed.ncbi.nlm.nih.gov/?term=Washiyama+N&cauthor_id=42900380)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42900380/#full-view-affiliation-3 "Division of Cardiovascular Surgery, Department of Surgery 1, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan."), [Yuki Takeuchi](https://pubmed.ncbi.nlm.nih.gov/?term=Takeuchi+Y&cauthor_id=42900380)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42900380/#full-view-affiliation-3 "Division of Cardiovascular Surgery, Department of Surgery 1, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan."), [Kazuma Okamoto](https://pubmed.ncbi.nlm.nih.gov/?term=Okamoto+K&cauthor_id=42900380)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42900380/#full-view-affiliation-3 "Division of Cardiovascular Surgery, Department of Surgery 1, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan."), [Yoshiki Nakajima](https://pubmed.ncbi.nlm.nih.gov/?term=Nakajima+Y&cauthor_id=42900380)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42900380/#full-view-affiliation-2 "Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan.") Affiliations Expand ### Affiliations * 1 Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan. anezaki.hiroki@gmail.com. * 2 Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan. * 3 Division of Cardiovascular Surgery, Department of Surgery 1, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan. * PMID: **42900380** * DOI: [ 10.1007/s00540-026-03921-7 ](https://doi.org/10.1007/s00540-026-03921-7) Item in Clipboard # Stress hyperglycemia ratio as a marker of major postoperative complications after cardiac surgery with cardiopulmonary bypass Hiroki Anezaki et al. J Anesth. 2026. Show details Display options Display options Format Abstract PubMed PMID J Anesth Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Anesth%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Anesth%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42900380/) . 2026 Oct 20. doi: 10.1007/s00540-026-03921-7. Online ahead of print. ### Authors [Hiroki Anezaki](https://pubmed.ncbi.nlm.nih.gov/?term=Anezaki+H&cauthor_id=42900380)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42900380/#short-view-affiliation-1 "Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan. anezaki.hiroki@gmail.com."), [Soichiro Mimuro](https://pubmed.ncbi.nlm.nih.gov/?term=Mimuro+S&cauthor_id=42900380)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42900380/#short-view-affiliation-2 "Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan."), [Naoki Washiyama](https://pubmed.ncbi.nlm.nih.gov/?term=Washiyama+N&cauthor_id=42900380)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42900380/#short-view-affiliation-3 "Division of Cardiovascular Surgery, Department of Surgery 1, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan."), [Yuki Takeuchi](https://pubmed.ncbi.nlm.nih.gov/?term=Takeuchi+Y&cauthor_id=42900380)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42900380/#short-view-affiliation-3 "Division of Cardiovascular Surgery, Department of Surgery 1, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan."), [Kazuma Okamoto](https://pubmed.ncbi.nlm.nih.gov/?term=Okamoto+K&cauthor_id=42900380)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42900380/#short-view-affiliation-3 "Division of Cardiovascular Surgery, Department of Surgery 1, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan."), [Yoshiki Nakajima](https://pubmed.ncbi.nlm.nih.gov/?term=Nakajima+Y&cauthor_id=42900380)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42900380/#short-view-affiliation-2 "Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan.") ### Affiliations * 1 Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan. anezaki.hiroki@gmail.com. * 2 Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan. * 3 Division of Cardiovascular Surgery, Department of Surgery 1, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, 431-3192, Japan. * PMID: **42900380** * DOI: [ 10.1007/s00540-026-03921-7 ](https://doi.org/10.1007/s00540-026-03921-7) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Purpose:** This study examined whether the stress hyperglycemia ratio (SHR) at intensive care unit (ICU) admission is associated with major postoperative complications after cardiac surgery with cardiopulmonary bypass and whether this association differs from that of absolute ICU admission glucose. **Methods:** This single-center retrospective study included 731 surgical episodes from 709 adults who underwent cardiac surgery with cardiopulmonary bypass. SHR was calculated as the first ICU glucose divided by HbA1c-derived estimated average glucose. The primary outcome was an unweighted composite of 30-day mortality, stroke, Kidney Disease: Improving Global Outcomes stage 3 acute kidney injury, reoperation for bleeding, prolonged mechanical ventilation, and deep sternal wound infection. Multivariable logistic regression adjusted for clinically relevant covariates. **Results:** The composite outcome occurred in 90 surgical episodes (12.3%). SHR was associated with the composite outcome after adjustment (odds ratio [OR], 1.103 per 0.1 increase; 95% confidence interval [CI] 1.008-1.208; P = 0.033), whereas ICU admission glucose was not significantly associated (OR, 1.019 per 10 mg/dL increase; 95% CI 0.946-1.096; P = 0.626). **Conclusion:** SHR at ICU admission was associated with major postoperative complications in the primary analysis, whereas absolute ICU admission glucose was not significantly associated after multivariable adjustment. Confidence intervals for SHR included 1.0 in several sensitivity analyses. SHR warrants prospective evaluation as an early postoperative risk marker after cardiac surgery with cardiopulmonary bypass. **Keywords:** Cardiac surgery; Cardiopulmonary bypass; Intensive care unit; Postoperative complications; Stress hyperglycemia ratio. © 2026. The Author(s), under exclusive licence to Japanese Society of Anesthesiologists. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Conflict of interest: The authors declare that they have no conflicts of interest. Ethical approval: Ethical approval for this study was obtained from the Ethics Review Board of Hamamatsu University School of Medicine (approval number, 26–102). The requirement for written informed consent was waived because of the retrospective design, and an opt-out approach was used. The study was conducted in accordance with the principles of the Declaration of Helsinki. Because this was a retrospective observational study, trial registration was not required. Informed consent: The requirement for written informed consent was waived because of the retrospective design, and an opt-out approach was used. ## References 1. 1. Ascione R, Rogers CA, Rajakaruna C, Angelini GD. Inadequate blood glucose control is associated with in-hospital mortality and morbidity in diabetic and nondiabetic patients undergoing cardiac surgery. Circulation. 2008;118:113–23. - [DOI](https://doi.org/10.1161/circulationaha.107.706416) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/18591441/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/2847615/) 2. 1. Kourek C, Georgopoulou M, Kolovou K, Rouvali N, Panoutsopoulou M, Kinti C, Soulele T, Doubou D, Karanikas S, Elaiopoulos D, Karabinis A, Dimopoulos S. Intensive care unit hyperglycemia after cardiac surgery: risk factors and clinical outcomes. J Cardiothorac Vasc Anesth. 2024;38:162–9. - [DOI](https://doi.org/10.1053/j.jvca.2023.09.022) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/37880037/) 3. 1. Ruan J, Huang W, Jiang J, Hu C, Li Y, Peng Z, Cai S. Association between hyperglycemia at ICU admission and postoperative acute kidney injury in patients undergoing cardiac surgery: analysis of the MIMIC-IV database. J Intensive Med. 2024;4:526–36. - [DOI](https://doi.org/10.1016/j.jointm.2024.04.004) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/39310058/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/11411430/) 4. 1. Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ; A1c-Derived Average Glucose Study Group. Translating the A1C assay into estimated average glucose values. Diabetes Care. 2008;31:1473–8. - [DOI](https://doi.org/10.2337/dc08-0545) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/18540046/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/2742903/) 5. 1. Roberts GW, Quinn SJ, Valentine N, Alhawassi T, O’Dea H, Stranks SN, Burt MG, Doogue MP. Relative hyperglycemia, a marker of critical illness: introducing the stress hyperglycemia ratio. J Clin Endocrinol Metab. 2015;100:4490–7. - [DOI](https://doi.org/10.1210/jc.2015-2660) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/26485219/) Show all 21 references [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM **Send To** * [Clipboard](https://pubmed.ncbi.nlm.nih.gov/42900380/) * [Email](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42900380%2F%23open-email-panel) * [Save](https://pubmed.ncbi.nlm.nih.gov/42900380/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42900380%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42900380%2F%23open-collections-panel) * [Citation Manager](https://pubmed.ncbi.nlm.nih.gov/42900380/) [x] NCBI Literature Resources [MeSH](https://www.ncbi.nlm.nih.gov/mesh/) [PMC](https://www.ncbi.nlm.nih.gov/pmc/) [Bookshelf](https://www.ncbi.nlm.nih.gov/books) [Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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