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Association of stress hyperglycemia ratio and mortality in patients with sepsis: results from 13,199 patients

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The stress hyperglycemia ratio (SHR), adjusted for average glycemic status, is suggested for assessing actual blood glucose levels. Its link with adverse outcomes is known in certain populations, yet its impact on sepsis patients’ prognosis is unclear. This study explores the association between SHR and mortality in sepsis.


We included 13,199 sepsis patients in this study and categorized SHR into distinct groups. Additionally, we utilized restricted cubic spline analysis to evaluate the correlation between SHR as a continuous variable and mortality. The primary outcome was 1-year all-cause mortality. Logistic regression and Cox proportional hazards models were employed to assess the associations between the SHR and both in-hospital mortality and 1-year mortality, respectively.


Among the study participants, 4,690 (35.5%) patients died during the 1-year follow-up. After adjusting for confounding variables, we identified a U-shaped correlation between SHR and 1-year mortality. Using an SHR of 0.99 as the reference point, the hazard ratio for predicted 1-year mortality increased by 1.17 (95% CI 1.08 to 1.27) per standard deviation above 0.99, whereas each standard deviation increase predicted the hazard ratio of 0.52 (95% CI 0.39 to 0.69) below 0.99. Furthermore, we found that SHR could enhance the predictive performance of conventional severity scores.


There exists a U shaped association between SHR and mortality in sepsis patients, where both low and high SHR values are associated with an increased risk of poor outcomes.

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Data availability

The datasets used during the current study are available from the corresponding author upon reasonable request.


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This study was supported by the Medical and Health Technology Innovation Project of the Chinese Academy of Medical Sciences (2021-CXGC09-1).

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Authors and Affiliations



This study was designed by LL and LKZ. XP, ZXZ, LKZ, YLX, ZHZ, and ZH were responsible for data collation and statistical analysis. LL wrote the first draft. YY reviewed and checked the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yan Yao.

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The authors declare that they have no competing interests.

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Li, L., Zhou, L., Peng, X. et al. Association of stress hyperglycemia ratio and mortality in patients with sepsis: results from 13,199 patients. Infection (2024).

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