Multivariate analysis of 28-day mortality in ICU sepsis patients and the predictive value of stress hyperglycemia ratio combined with SOFA score

Objective To investigate the multivariate factors associated with 28-day mortality in intensive care unit (ICU) patients with sepsis and the predictive value of the stress hyperglycemia ratio (SHR) combined with the Sequential Organ Failure Assessment (SOFA) score. Methods A total of 302 patients with sepsis were retrospectively selected from the comprehensive ICU of our hospital from November 2021 to February 2025. Patients were divided into a survivor group ( n = 220) and a non-survivor group ( n = 82) based on 28-day mortality status. COX regression models were used to analyze factors influencing mortality. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance. Results Compared with the non-survivor group, the survivor group had lower proportions of mechanical ventilation, lower serum lactate (Lac), mean platelet volume/lymphocyte ratio (MPVLR), SHR, SOFA score, and APACHE II score ( P < 0.05 ). A COX regression equation was established with the death of ICU patients with sepsis as the binary outcome variable. Based on the multivariate COX regression model, the function model for predicting sepsis patient death was fitted as: h (t, X) = h0 (t) exp (prognostic index = 0.782 × mechanical ventilation+0.849 × Lac + 1.271 × MPVLR + 1.517 × SHR + 0.936 × SOFA score). An additional 100 sepsis patients were selected and substituted into the combined diagnostic model. The sensitivity was 79.49% (31/39), specificity was 90.16% (55/61), accuracy was 86.00% [(31 + 55)/100]. The area under the curve (AUC) of SHR combined with SOFA score for predicting death in ICU sepsis patients was 0.911, with specificity and sensitivity of 84.15% and 88.18%, respectively. The AUC of the combined detection was significantly higher than that of SHR alone (Z = −3.021, P < 0.05 ). SHR combined with SOFA score revealed the predictive value for mortality in ICU sepsis patients. Conclusions Mechanical ventilation, blood lactate ≥ 5.82 mmol/L, MPVLR ≥ 9.74, SHR ≥ 1.56, and SOFA score ≥ 9 were independent risk factors for mortality in ICU patients with sepsis. The combination of SHR and SOFA score showed superior AUC compared to single indicators and may serve as a rapid prognostic assessment tool within 24 h of admission.