Xiaoxue Qu, Yan Yang, Tuo Xu, Dezhi Liu Department of Critical Care Medicine, Xinxiang Central Hospital, Xinxiang, Henan, 453000, People’s Republic of ChinaCorrespondence: Dezhi Liu, Department of Critical Care Medicine, Xinxiang Central Hospital, 56 Jinshui Avenue, Xinxiang, Henan, People’s Republic of China, Email doctorldz@163.comBackground: Previous studies have shown that stress-induced increases in blood sugar and inflammation are closely associated with the mortality risk in sepsis patients. The stress hyperglycemia ratio (SHR) and the aggregate index of systemic inflammation (AISI) are commonly used as key indicators to assess stress-induced blood glucose levels and inflammatory load. However, the relationship between these two factors and adverse outcomes in sepsis patients remains unclear.Methods: This study adopted a retrospective cohort study design, selecting 1509 patients with sepsis from a self-registered cohort and the MIMIC-IV database. Cox regression analyzed associations between SHR, AISI, their interaction, and mortality. Cumulative risk curves evaluated mortality across groups, and the C-index assessed predictive performance of the combined metric. We also compared hospitalization and ICU stay durations among groups.Results: The Cox regression analysis showed that both elevated SHR and AISI were strongly associated with an increased risk of death in sepsis patients, and their combination further amplified this risk. Specifically, the high SHR and high AISI groups had significantly higher mortality compared to the low SHR and low AISI groups. Additionally, the combined effect of SHR and AISI achieved a C-index of 0.7 for overall mortality, demonstrating a stronger predictive ability. The ICU stay duration was also significantly longer in the high SHR and high AISI groups.Conclusion: The combined effects of SHR and AISI are strongly correlated with increased mortality and prolonged ICU stays in sepsis patients. Early control of stress glucose levels and inflammation may not only reduce death risk but also shorten ICU stays, aiding precision medicine and potentially reducing economic burden.Keywords: stress hyperglycemia ratio, aggregate index of systemic inflammation, intensive care unit, sepsis, mortality risk
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