Combined hemoglobin glycation index and RDW/LDL-C ratio predict severe sepsis and/or septic shock in diabetic patients with Enterobacteriaceae bloodstream infections

Objective To investigate the predictive value of hemoglobin glycation index (HGI) and red cell distribution width/low-density lipoprotein cholesterol ratio (RDW/LDL-C) for progression to severe sepsis and/or septic shock following Enterobacteriaceae bloodstream infection in diabetic patients. Methods This retrospective study included 203 diabetic patients with concomitant Enterobacteriaceae bloodstream infections. Clinical data were collected, and the HGI and RDW/LDL-C were calculated. Patients were grouped into quartiles (Q1-Q4) based on combined indicator quartiles. Multivariate logistic regression analysis was performed to assess the association with severe infection risk, and predictive performance was evaluated using ROC curves. Results Patients in the severe group exhibited significantly higher HGI and RDW/LDL-C levels compared to the non-severe group (both p  < 0.05). Multivariate analysis showed that after adjusting for source of infection (Model 1) and comorbidities (Model 2), with Q1 as the reference group, Q2 and Q4 were independent predictors of severe sepsis and/or septic shock, respectively. ROC curve analysis indicated that the combined HGI-RDW/LDL-C index had an area under the curve (AUC) of 0.760 (95% CI: 0.693–0.826) for predicting severe sepsis and/or septic shock. Furthermore, the proportion of Klebsiella pneumoniae infections and antibiotic resistance patterns exhibited specific distributions within the high combined index group. Conclusion The HGI-RDW/LDL-C composite index serves as an independent risk factor for progression to severe sepsis and/or septic shock following Enterobacteriaceae bloodstream infection in diabetic patients, demonstrating good predictive value.