Accepted for/Published in: JMIR Medical Informatics
Date Submitted: Aug 6, 2025
Date Accepted: Feb 28, 2026
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Associations of stress hyperglycemia ratio with sepsis risk in heart failure patients: a retrospective cohort study from MIMIC-IV
ABSTRACT
Background:
Studies regarding the relationship between stress hyperglycemia ratio (SHR) and sepsis occurrence in heart failure (HF) patients are limited.
Objective:
This study investigates the association between SHR and sepsis occurrence in HF patients, and explores the potential mediating role of inflammatory indicators.
Methods:
There were 1205 HF patients included and divided into groups based on quartiles of the SHR. The primary endpoint was 7-day sepsis incidence. The multivariate Cox regression, restricted cubic spline (RCS) analysis, subgroup analysis, and mediation analysis were employed, along with Fine-Gray and competing risk models for sensitivity analysis.
Results:
In the cohort (mean age 71.51 years, 63.4% male), 162 (13.4%) patients with HF experienced sepsis within 7 days. After adjusting for confounders, a per-unit SHR increase was linked to an 18% higher sepsis risk (HR 1.18, 95% CI 1.01–1.38, P = 0.042). The RCS revealed an inverted L-shaped relationship between SHR and sepsis occurrence (p for non-linear = 0.017), with a more significant impact in diabetic subgroup (p for interaction = 0.012). Moreover, even considering 7-day mortality as a competing risk, the Fine-Gray model confirmed SHR be significantly associated with sepsis incidence (p = 0.014). Mediation analysis showed that inflammatory indices, including Systemic Inflammatory Response Index (SIRI), mediated 6%-13% of the association in the general HF population, with stronger mediation (37%-47%) in non-diabetic subgroups.
Conclusions:
The elevated SHR is associated with increased 7-day sepsis risk in HF patients, especially for those combined with diabetes, and inflammatory indices partially mediate the positive association between SHR and sepsis occurrence. Clinical Trial: no
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