Influence of Stress Hyperglycemia on In-Hospital Mortality in Older Patients with Sepsis: A Retrospective Analysis

Background: Stress hyperglycemia, a critical illness response, is linked to poor outcomes. Its impact on geriatric sepsis patients remains unclear. This study investigates stress hyperglycemia’s influence in geriatric sepsis patients. Methods: These patients were identified by searching the 10th revision of the International Classification of Diseases codes that were sepsis-related diagnoses, and they were categorized into two age groups: 18–65 years and over 65 years. Stress hyperglycemia was assessed using the glycemic gap (the difference between admission glucose and estimated average glucose (eAG)) and glycemic ratio (the ratio of admission glucose to eAG). Mortality risk during hospitalization was assessed using logistic regression and ROC analysis. Results: The study analyzed 16,582 sepsis patients, with 9,602 in the older group (≥ 65 years) and 6,980 in the younger group. The diabetic patients were 29.5% in the younger group and 37.7% in the older group. Comorbidities, except obesity, were more prevalent in the older group. The older group had higher initial glucose levels, while younger patients had higher HbA1C levels. In younger patients, a higher glycemic ratio was significantly associated with increased in-hospital mortality (p = 0.0492). In contrast, among older diabetic patients, both the glycemic gap and ratio were lower in non-survivors than in survivors, and a higher glycemic ratio was independently associated with reduced mortality (ad-justed RR = 0.67, 95% CI = 0.451–0.996, p = 0.048). Conclusion: Stress hyperglycemia in older sepsis patients may indicate preserved endocrine function and a better prognosis, warranting age-specific hyperglycemia management strategies.