Association of Stress Hyperglycemia Ratio with Sepsis and Mortality in Critically Ill Stroke Patients: A Retrospective Cohort Study from MIMIC-IV.

Background: Stress-induced hyperglycemia (SIH) has been associated with poor outcomes in stroke patients. However, the relationship between SIH and sepsis in this population remains understudied. We aimed to evaluate the association of SIH, measured using the stress hyperglycemia ratio (SHR), with the development of sepsis and mortality among critically ill stroke patients. Methods: We retrospectively analyzed stroke patients requiring ICU admission from the MIMIC-IV database. Primary outcome was sepsis, and secondary outcomes were 30-day and 90-day all-cause mortality. Multivariable Cox and logistic regression models were used to evaluate associations. Results: A total of 3018 patients were included (66.8% ischemic stroke). After full adjustment for confounders, SHR was independently associated with an increased risk of sepsis (Q4 vs Q1: OR 1.46, 95% CI: 1.12-1.89, P = 0.005; continuous SHR: OR 1.31, P = 0.010). SHR also demonstrated a strong dose-response relationship with mortality; patients in Q4 had significantly higher risks of 30-day (OR 2.95, 95% CI: 2.25-3.88, P < 0.001) and 90-day mortality (OR 2.25, 95% CI: 1.80-2.82, P < 0.001). Subgroup analyses revealed significant interactions between SHR and stroke type for sepsis (P for interaction = 0.014), with a more pronounced effect observed in ischemic stroke patients. The associations between SHR and both sepsis and mortality were consistently maintained regardless of the presence of diabetes (all P < 0.050). Conclusion: Elevated stress hyperglycemia ratio is independently associated with higher risks of sepsis and short-to long-term mortality among critically ill patients with stroke, with consistent associations observed irrespective of diabetes status. In contrast, no statistically significant association between SHR and sepsis was identified in the hemorrhagic stroke subgroup.