Integrating Admission Hyperglycemia Into Multidisciplinary Risk Stratification for Sepsis in the ICU: A Retrospective Cohort Study

Background: Hyperglycemia is a frequently observed metabolic derangement among critically ill patients in the intensive care unit (ICU). It is known to be associated with impaired immune responses and an elevated risk of severe infections, including sepsis. While this association has been extensively documented in high-income countries, evidence from developing nations such as Indonesia remains conspicuously limited, particularly regarding admission hyperglycemia as a prognostic indicator for sepsis. Managing this complex interaction requires a robust, multidisciplinary approach. Purpose: To evaluate the independent association between admission hyperglycemia and the incidence of sepsis among critically ill ICU patients, adjusting for potential confounders including age, length of ICU stay, and comorbidities, in order to inform collaborative clinical pathways. Methods: Using convenience sampling, this retrospective cohort study included 290 adult patients (≥ 18 years) admitted to the ICU between January 2021 and December 2025. Admission blood glucose levels were categorized into euglycemia (71– 140 mg/dL), mild hyperglycemia (141– 200 mg/dL), and severe hyperglycemia (> 200 mg/dL). The diagnosis of sepsis was determined based on the clinical assessment of the attending physicians. Data were analyzed using multivariable logistic regression. Results: Of the 290 critically ill patients analyzed, 159 (54.8%) developed sepsis. Multivariable analysis demonstrated that severe admission hyperglycemia significantly amplified the risk of sepsis (adjusted Odds Ratio aOR = 2.54; 95% Confidence Interval CI: 1.33– 4.85; p = 0.005). Furthermore, advanced age (> 65 years) (aOR = 1.80; 95% CI: 1.10– 2.93; p = 0.019) and the presence of multiple comorbidities (≥ 2) (aOR = 2.16; 95% CI: 1.28– 3.67; p = 0.004) were identified as independent predictors. Mild hyperglycemia did not exhibit a statistically significant association with sepsis incidence. Conclusion: Severe admission hyperglycemia (> 200 mg/dL) serves as a robust, independent predictor of sepsis in critically ill patients. Routine blood glucose screening at ICU admission is crucial for early risk stratification. Establishing a coordinated, multidisciplinary protocol integrating physicians, critical care nurses, clinical pharmacists, and dietitians is essential to optimize targeted metabolic interventions and effectively mitigate the sepsis burden. Keywords: admission hyperglycemia, early medical intervention, intensive care units, patient care team, retrospective studies, sepsis