C-Reactive protein-triglyceride glucose index and controlling nutritional status score for predicting severe sepsis or septic shock in diabetic patients with Enterobacteriaceae bloodstream infections

Objective To investigate the value of the C-reactive protein-triglyceride glucose index (CTI) and the controlling nutritional status score (CONUT) in predicting the risk of progression to severe sepsis or septic shock in patients with diabetes complicated by Enterobacteriaceae bloodstream infections. Methods A total of 236 patients with diabetes complicated by Klebsiella pneumoniae or Escherichia coli bloodstream infections from January 2023 to December 2025 were enrolled. Patients were grouped based on CTI quartiles (Q1-Q4) and CONUT scores (normal-low risk, moderate risk, high risk). Demographic, clinical characteristics, and laboratory indicators were collected to analyze intergroup differences and their association with severe clinical outcomes (severe sepsis or septic shock). Multivariate logistic regression models adjusted for confounding factors, and ROC curves evaluated the predictive ability of combined CTI and CONUT indices. Results The study found that as the CTI quartile increased, the incidence of sepsis ( p  < 0.001) and in-hospital mortality ( p  = 0.009) significantly increased. The CONUT high-risk group exhibited a particularly high sepsis incidence of 89.8% ( p  < 0.001), with more pronounced trends toward elevated HbA1c levels and decreased platelet counts ( p  < 0.05). Significant correlations were observed between CTI and HbA1c levels. Within different CONUT score groups, the high-risk group demonstrated markedly higher HbA1c levels compared to the normal light exposure group. Multivariate regression analysis revealed that CTI Q4 (adjusted OR = 5.301, 95% CI: 2.054–13.679, p  = 0.001) and moderate/high CONUT scores (adjusted OR = 3.379 and 5.099, respectively, p  < 0.001) were independent predictors of severe outcomes. ROC analysis indicated that the area under the curve (AUC) for combined CTI and CONUT scores in predicting severe outcomes was 0.777 (95% CI: 0.716–0.837), outperforming either single indicator. Conclusion Both CTI and CONUT scores were effective indicators for predicting severe sepsis or septic shock in patients with diabetes complicated by Enterobacteriaceae bloodstream infections.