A single-centre study found that a higher stress hyperglycaemia ratio was linked to greater risk of acute heart failure before surgery in older patients with chronic cerebrovascular disease.
A study published on the Dove Press platform suggests that the stress hyperglycaemia ratio, a measure that compares admission glucose with longer-term glycaemic control, may help identify older hip-fracture patients with chronic cerebrovascular disease who are at higher risk of acute heart failure before surgery. In the retrospective single-centre analysis of 515 patients, 87 developed heart failure before their operation, and the authors found that higher ratios were linked to greater risk, with the curve of risk rising more sharply once the ratio moved above about 1.3. The findings add to earlier research showing that the ratio has prognostic value in other settings, including critical illness and sepsis, although those studies involved different patient groups and outcomes.
The researchers defined acute heart failure using a combination of symptoms, clinical examination, laboratory testing and imaging, in line with the 2022 American Heart Association, American College of Cardiology and Heart Failure Society of America guideline. That approach matters because the study focused on patients whose physiological reserve was already limited by age, fracture-related stress and chronic cerebrovascular disease. In that setting, the authors argue, a simple blood-based marker may capture metabolic strain that traditional pre-operative assessment can miss.
Alongside the stress hyperglycaemia ratio, the study identified coronary heart disease, higher American Society of Anesthesiologists grade, elevated neutrophils and hypoproteinaemia as independent predictors of heart failure before surgery. Those findings are consistent with earlier hip-fracture research showing that age, coronary disease, anaemia and low albumin are important markers of cardiac vulnerability in this population. Another hip-fracture study, also in older adults, found that hypertension, anaemia and hypoalbuminaemia were linked to heart failure after surgery, reinforcing the broader point that cardiac risk in these patients is closely tied to comorbidity burden and nutritional status.
The authors also compared a conventional nomogram with several machine-learning models. On internal validation, XGBoost performed best, with reported discrimination stronger than the simpler clinical model. Even so, the paper’s own caution is important: the work was retrospective, came from a single centre in China and lacked external validation, so the results should be treated as promising rather than definitive.
Taken together, the study points to a practical lesson for pre-operative care in frail older adults with hip fracture: a routine admission glucose result may be more informative when read alongside HbA1c and translated into a stress hyperglycaemia ratio. The authors suggest that incorporating that measure into peri-operative assessment could improve risk stratification, particularly in patients with existing cerebrovascular disease, but they also acknowledge that larger prospective studies will be needed before the model can be adopted more widely.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
