Predictive value of stress-induced hyperglycemia for 28-day all-cause mortality in ICU patients with sepsis: a MIMIC-IV-based retrospective cohort study.

BACKGROUND: This study explored the link between Stress-Induced Hyperglycemia (SIH) and 28-Day All-Cause Mortality (28D-ACM) in patients with sepsis, focusing on the predictive values of stress hyperglycemia ratios 1 and 2 (SHR1 and SHR2) and Glucose Gap (GG). METHODS: This retrospective cohort study included ICU patients with sepsis from the MIMIC-IV database. The relationships between the three SIH metrics and 28D-ACM risk were analyzed using multivariate Cox proportional hazards models, Kaplan-Meier curves, and restricted cubic spline analysis. The predictive performances of these metrics within a basic model were assessed using the Receiver Operating Characteristic (ROC) curve and Integrated Discrimination Improvement (IDI) index. RESULTS: The study included 12,582 ICU patients with sepsis, with a 28D-ACM rate of 13.63%. In the fully adjusted model, SHR1, SHR2, and GG were independently associated with 28D-ACM risk, with Hazard Ratios (HR) and 95% Confidence Intervals (95% CIs) of 1.158 (1.029, 1.304), 1.18 (1.046, 1.332), and 1.133 (1.008, 1.275), respectively. Increased SIH metrics correlated positively with higher mortality risk (ptrend< 0.05). The Kaplan-Meier curve indicated that higher tertiles of SHR1, SHR2, and GG resulted in increased cumulative incidence of 28D-ACM (p < 0.05). Additionally, integrating SHR1 and SHR2 enhanced the model's predictive accuracy for 28D-ACM (p < 0.05). CONCLUSIONS: SHR1, SHR2, and GG are significantly associated with 28D-ACM risk in ICU patients with sepsis. SHR1 showed statistical association with mortality and modest incremental value, but clinical utility for risk stratification is limited and needs external validation.