SHR and SIRI Improve CHD Detection in Type 2 Diabetes

A retrospective angiography study in T2DM suggests that pairing a stress-glycemia index (SHR) with an inflammation index (SIRI) improves CHD risk stratification compared with using either marker alone.

Why CHD is a high-stakes problem in T2DM

Coronary heart disease (CHD) is “one of the most prevalent and fatal health conditions,” and it continues to pose a considerable public health burden despite “significant advancements in interventional medical technology.” The authors note that patients with type 2 diabetes mellitus (T2DM) are at particularly high risk: diabetic patients “exhibit a markedly higher risk of mortality following the onset of CHD” than their non-diabetic counterparts. Given the rising prevalence of diabetes, vigilant monitoring of this population is imperative.

The rationale for using these two biomarkers?

The study is built around two calculated indices:

• Stress hyperglycemia ratio (SHR). The authors describe “stress-induced hyperglycemia” as markedly elevated glucose caused by physiological or pathological stressors. Admission glucose can predict CHD mortality in people with diabetes, but it “does not account for the effects of chronic glycemic dysregulation.” SHR—introduced to better assess in-hospital glucose status—integrates admission fasting glucose with HbA1c to quantify acute-on-chronic glycemic change.

• Systemic inflammation response index (SIRI). The article describes systemic chronic inflammation as an important contributor to diabetic vascular complications, intensifying insulin resistance and endothelial dysfunction. SIRI, derived from neutrophil, lymphocyte, and monocyte counts, is presented as a composite indicator of systemic inflammatory burden that has drawn attention in cardiovascular research.

The authors’ question was straightforward: does combining SHR and SIRI improve CHD detection in T2DM?

Study snapshot

Guo et al. analyzed 943 patients with T2DM who underwent coronary angiography (CAG) at Linquan County People’s Hospital (September 2023–May 2025). CHD was defined as ≥50% stenosis in one or more major coronary arteries on CAG. They used multivariable logistic regression and restricted cubic splines to test associations, then evaluated discrimination with ROC (AUC) and reclassification metrics (net reclassification improvement [NRI], integrated discrimination improvement [IDI]). Internal validation used 1000 bootstraps, with calibration testing and decision curve analysis.

Key findings in numbers

• CHD was present in 600 of 943 patients (63.6%).

• In fully adjusted models, SHR and SIRI were independently associated with CHD (SHR: odds ratio (OR) 1.68; 95% CI 1.14–2.46; SIRI: OR 2.17; 95% CI 1.54–3.05).

• Discrimination improved when the indices were combined: area under the curve (AUC) 0.813 for SHR+SIRI versus 0.773 (SHR alone) and 0.745 (SIRI alone). Sensitivity/specificity for the combined model were 81.5%/71.1%.

• The combined approach significantly improved NRI and IDI compared with either marker alone; in bootstrap validation, the combined model achieved a bias-corrected AUC of 0.846 with non-significant Hosmer–Lemeshow results (P > 0.05).

• For “initial risk stratification,” the authors proposed cutoffs of 0.84 (SHR) and 0.48 (SIRI) based on their ROC analysis.

What’s new—and why it might matter

“This research represents the first investigation into the discriminative performance of combining SHR and SIRI to predict CHD in patients with T2DM.”

In the discussion, the authors point to a bidirectional connection: stress hyperglycemia can promote inflammation and oxidative stress, while chronic inflammation may worsen insulin signaling and hyperglycemia, potentially creating a self-reinforcing cycle. This offers a mechanistic rationale for evaluating SHR and SIRI together.

Implications and next steps

The authors suggest that an integrative assessment of SHR and SIRI “may enable clinicians to more accurately identify high-risk patients for CHD” and support early intervention, alongside traditional cardiovascular risk indicators.

They also flag important limitations: the retrospective design cannot establish causality; key prognostic variables were unavailable (including diabetes duration, baseline eGFR, and albuminuria); and the single-center, CAG-referred cohort may not generalize to broader, asymptomatic T2DM populations. They call for multi-center prospective validation, including community-based cohorts.

Bottom line

In a T2DM cohort undergoing coronary angiography, SHR and SIRI were each associated with CHD, and their combination improved discriminative performance compared with either marker alone—supporting prospective validation of a simple, two-index approach to CHD risk stratification in T2DM.

 

The translation of the preceding English text in Chinese:

 

一项针对 T2DM 的回顾性冠状动脉造影研究提示，将应激血糖指数（SHR）与炎症指数（SIRI）相结合，相较于单独使用任一指标，可改善 CHD 的风险分层。

为什么 CHD 在 T2DM 中是一个高风险问题

冠状动脉粥样硬化性心脏病（CHD）是“最常见且致死率最高的健康状况之一”，尽管“介入医学技术已取得显著进步”，但其仍然对公共卫生构成沉重负担。作者指出，2 型糖尿病（T2DM）患者的风险尤为突出：与非糖尿病人群相比，糖尿病患者在 CHD 发病后的死亡风险“显著更高”。鉴于糖尿病患病率不断上升，对这一人群进行严密监测至关重要。

为何选择这两种生物标志物？

该研究围绕两个计算得出的指数展开：

• 应激性高血糖比值（stress hyperglycemia ratio，SHR）。作者将“应激性高血糖”描述为由生理或病理应激因素引起的显著血糖升高。入院血糖可预测糖尿病患者的 CHD 死亡风险，但它“未能反映慢性血糖失调的影响”。SHR 旨在更好地评估住院期间的血糖状态，通过整合入院空腹血糖与 HbA1c，用以量化急性叠加于慢性的血糖变化。
• 全身炎症反应指数（systemic inflammation response index，SIRI）。文章指出，全身性慢性炎症是糖尿病血管并发症的重要促进因素，可加重胰岛素抵抗和内皮功能障碍。SIRI 由中性粒细胞、淋巴细胞和单核细胞计数计算而来，被视为反映全身炎症负荷的综合指标，近年来在心血管研究中受到关注。

作者的问题很直接：将 SHR 与 SIRI 结合，是否能提高 T2DM 患者中 CHD 的检出能力？

研究概览

Guo 等分析了 943 例在临泉县人民医院接受冠状动脉造影（CAG）的 T2DM 患者（2023 年 9 月—2025 年 5 月）。CHD 定义为 CAG 显示一条或多条主要冠状动脉狭窄 ≥50%。研究采用多变量 Logistic 回归和限制性立方样条检验相关性，并通过 ROC（AUC）及再分类指标（净再分类改善［NRI］、综合判别改善［IDI］）评估判别能力。内部验证采用 1000 次自助法（bootstrap），并进行了校准检验和决策曲线分析。

关键结果（数字）

943 例患者中，600 例存在 CHD（63.6%）。

在完全调整模型中，SHR 和 SIRI 均与 CHD 独立相关（SHR：比值比［OR］1.68；95% CI 1.14–2.46；SIRI：OR 2.17；95% CI 1.54–3.05）。

将两项指数结合后，判别能力提高：SHR+SIRI 的曲线下面积（AUC）为 0.813，而 SHR 单独为 0.773，SIRI 单独为 0.745。联合模型的灵敏度/特异度分别为 81.5%/71.1%。

与单一指标相比，联合方法在 NRI 和 IDI 上均有显著改善；在 bootstrap 验证中，联合模型的偏倚校正 AUC 达到 0.846，Hosmer–Lemeshow 检验结果不显著（P > 0.05）。

基于 ROC 分析，作者为“初始风险分层”提出的截点值为 SHR 0.84、SIRI 0.48。

新意何在——以及其潜在意义

“本研究是首次评估将 SHR 与 SIRI 结合用于预测 T2DM 患者 CHD 判别性能的研究。”

在讨论中，作者指出二者之间可能存在双向联系：应激性高血糖可促进炎症和氧化应激，而慢性炎症又可能加重胰岛素信号障碍和高血糖，从而形成自我强化的循环。这为同时评估 SHR 和 SIRI 提供了机制学依据。

临床意义与后续研究

作者认为，对 SHR 与 SIRI 进行整合评估“可能有助于临床医生更准确地识别 CHD 高风险患者”，并在传统心血管危险指标的基础上支持早期干预。

他们也指出了重要局限性：回顾性设计无法确立因果关系；部分关键预后变量缺失（包括糖尿病病程、基线 eGFR 和白蛋白尿）；且单中心、接受 CAG 的研究人群可能无法推广至更广泛、无症状的 T2DM 人群。作者呼吁开展多中心前瞻性验证研究，并纳入社区人群。

总结

在一项接受冠状动脉造影的 T2DM 队列中，SHR 和 SIRI 均与 CHD 相关，且二者联合较单独使用任一指标具有更好的判别性能——支持对这一简便的双指标 CHD 风险分层方法在 T2DM 人群中进行前瞻性验证。

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Reference:

Zixuan Guo, Siqi Song, Hao Cheng, Changxu Xie, Meng Zhang, Mengyang Pei, Mengting Liu, Zican Shen

Combined SHR and SIRI biomarkers predict increased coronary heart disease risk in type 2 diabetes.

Biomol Biomed [Internet]. 2025 Sep. 10 [cited 2025 Dec. 26];26(3):441–451.

Available from: https://www.bjbms.org/ojs/index.php/bjbms/article/view/13032

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