Association between stress hyperglycemia ratio index and all-cause mortality in patients with aortic dissection

Stress hyperglycemia, a temporary rise in blood glucose during acute illness, is linked to worse outcomes in cardiovascular diseases. The stress hyperglycemia ratio (SHR), calculated using admission glucose and HbA1c, may better reflect metabolic stress. Its value in predicting outcomes in aortic dissection (AD) remains unclear. We conducted a retrospective study of 1452 AD patients—1223 from the First Affiliated Hospital of Shantou University Medical College and 229 from the MIMIC-IV database. Patients were divided into SHR quartiles. Cox models assessed associations with all-cause mortality at 30, 90, 180, and 365 days. Restricted cubic spline (RCS) models explored nonlinear patterns. For the patients from the Asian center, median age was 61 years, and 75.3% were male. Higher SHR was linked to increased mortality at all time points (log-rank P < 0.01). Cox analysis showed significantly higher risk in the top SHR quartile. Similar results were found in the MIMIC-IV group. In the whole datasets, RCS revealed a U-shaped curve, with inflection points at 0.99 for 30-day and 0.96 for 365-day mortality. Patients above these points had over 100% increased risk of death (30-day HR 2.08, 95% CI 1.50–2.88; 365-day HR 2.32, 95% CI 1.76–3.05). SHR is an independent, nonlinear predictor of all-cause mortality in AD patients. Both low and high SHR levels are associated with worse outcomes. SHR may serve as a simple, low-cost tool for early risk stratification and glycemic management.