Association between the stress hyperglycemia ratio and multiple organ dysfunction syndrome incidence in trauma patients: a retrospective cohort study.

Abstract

Trauma patients experience significant stress states, leading to physiological and pathological changes. Severe trauma may result in multiple organ dysfunction syndrome (MODS). This study aims to evaluate the association between the stress hyperglycemia ratio (SHR) and MODS in trauma patients. Clinical data from 784 trauma patients were extracted from the MIMIC-IV (3.1) database. Based on clinical diagnoses, trauma patients were divided into a diabetic trauma group and a non-diabetic trauma group. Each group was further stratified into three subgroups according to SHR tertiles. The outcome was the development of MODS within 7 days of ICU admission. We investigated the association between SHR tertiles and MODS by logistic regression, with additional exploration using restricted cubic splines (RCS) to validate the findings. Data from 784 trauma patients were analyzed. Among non-diabetic patients, a higher SHR was consistently and significantly associated with an increased risk of MODS. When analyzed by tertiles and compared to the first tertile (T1), the third tertile (T3) showed a crude OR of 2.48 (95 % CI: 1.57-3.98, P < 0.001). This association remained significant after adjustment for covariates (adjusted OR = 2.10, 95 % CI: 1.20-3.72, P = 0.010). This non-linear association was further validated by restricted cubic spline (RCS) analysis, which revealed a risk pattern with little change in the first tertile, a mildly increasing risk in the second tertile, and a continued increase that eventually plateaued at a high level in the third tertile. In contrast, no significant association was observed between high SHR and MODS in the diabetic trauma group. In the non-diabetic trauma group, elevated SHR showed a significant association with MODS occurrence, whereas no significant association was observed between high SHR and MODS in the diabetic trauma group.