LAUSR

Abstract This study investigated stress hyperglycemia ratio (SHR) for acute kidney injury (AKI) and clinical outcomes in intensive care unit (ICU). Key outcomes were AKI within 48 h after ICU admission, acute kidney disease (AKD), ICU mortality, 28-day mortality, 90-day mortality and 1-year mortality. The associations between SHR and outcomes was estimated via logistic regression, Cox proportional hazards regression, and restricted cubic spline (RCS) analyses. Subgroup analyses assessed the consistency of these associations. Totally 3,714 patients were included from the Medical Information Mart for Intensive Care IV. SHR was associated with an increased risk of AKI (ORadjusted 1.29 95%CI 1.05–1.59). Among AKI patients, SHR was associated with increased risks of AKD (ORadjusted 1.94 95%CI 1.57–2.39), ICU mortality (ORadjusted 2.31 95%CI 1.60–3.32), 28-day mortality (HRadjusted 1.39 95%CI 1.29–1.50), 90-day mortality (HRadjusted 1.37 95%CI 1.26–1.48), and 1-year mortality (HRadjusted 1.37 95%CI 1.27–1.47). RCS analysis revealed a linear relationship with AKI, a J-shaped relationship with AKD, and a U-shaped relationship with mortality. Subgroup analysis confirmed the consistency of relationship between SHR and AKI. SHR demonstrates significant associations with AKI incidence, and correlates with AKD progression/mortality in critically ill adult ICU patients, suggesting its potential as a risk stratification and prognostic tool for AKI management, though further prospective validation is required.