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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jan 15, 2026; 17(1): 112621
Published online Jan 15, 2026. doi: 10.4239/wjd.v17.i1.112621
Published online Jan 15, 2026. doi: 10.4239/wjd.v17.i1.112621
Combined assessment with stress hyperglycemia ratio and time in range: Associations with twenty-eight-day mortality in surgical intensive care unit patients
Shuang Liu, Bai-Ge Cao, Cong-Rong Wang, Department of Endocrinology and Metabolism, Shanghai Fourth People’s Hospital Affiliated to Tongji University, Shanghai 200434, China
Shuang Liu, Bai-Ge Cao, Yue Ma, Cong-Rong Wang, School of Medicine, Tongji University, Shanghai 200434, China
Yue Ma, Department of Laboratory Medicine, Zhongda Hospital Southeast University, Nanjing 210004, Jiangsu Province, China
Jin-Fang Xu, Department of Military Health Statistics, Naval Medical University, Shanghai 200433, China
Quan-Hong Zhou, Department of Critical Care Medicine, Shanghai Sixth People’s Hospital, Shanghai 200233, China
Co-first authors: Shuang Liu and Bai-Ge Cao.
Co-corresponding authors: Quan-Hong Zhou and Cong-Rong Wang.
Author contributions: Liu S and Cao BG made equal contributions as co-first authors; Wang CR and Zhou QH performed study design and interpretation as co-corresponding authors; Liu S assisted with data analyses; Ma Y, Liu S, and Cao BG were involved in study conduct and data acquisition. All authors were involved in data interpretation, participated in manuscript preparation, planned the initial draft of the manuscript, and approved the final version for submission.
Supported by Shanghai Science and Technology Development Funds, No. 22410713200; The Noncommunicable Chronic Diseases-National Science and Technology Major Project, No. 2023ZD0509206; National Natural Science Foundation of China, No. 82471893; Key Discipline Project of Hongkou District Health Commission, No. HKLCFC202403; and Research fund from Shanghai Fourth People’s Hospital, No. sykyqd01801 and No. SY-XKZT-2021-1001.
Institutional review board statement: This study protocol was approved by the Ethics Committees of Shanghai Sixth People’s Hospital, No. 2024-KY-012(K).
Informed consent statement: Written informed consent was obtained from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data supporting the conclusions of this article are available from the corresponding author upon reasonable request, subject to ethical approval and participant privacy protections.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cong-Rong Wang, PhD, Professor, Department of Endocrinology and Metabolism, Shanghai Fourth People’s Hospital Affiliated to Tongji University, No. 1279 Sanmen Road, Shanghai 200434, China. crwang@tongji.edu.cn
Received: August 1, 2025
Revised: September 13, 2025
Accepted: November 28, 2025
Published online: January 15, 2026
Processing time: 166 Days and 13.2 Hours
Revised: September 13, 2025
Accepted: November 28, 2025
Published online: January 15, 2026
Processing time: 166 Days and 13.2 Hours
Core Tip
Core Tip: While the stress hyperglycemia ratio (SHR) has been widely examined as a marker of acute glycemic disturbance, prior studies have largely emphasized its independent prognostic value, often neglecting its interaction with longitudinal glycemic control indicators. In this study, we evaluated the combined effect of SHR and time in range (TIR) on 28-day mortality in surgical ICU patients. We found that patients with both elevated SHR and reduced TIR exhibited the highest risk of death, with a 2.37-fold increase compared to those with low SHR and high TIR. These findings highlight the prognostic relevance of both acute hyperglycemia and persistent glycemic dysregulation, and emphasize the potential value of integrated glucose management strategies in critically ill patients.