The relationship between gender identity, economic stressors, social support, concurrent substance use and suicidal ideation.

Patients with diabetes are at an increased risk of infection and progression to sepsis due to hyperglycemia-induced impairments in immune, neurological, and vascular function. These impairments include defective neutrophil migration and chemotaxis, reduced complement activity, and altered cytokine responses, which collectively compromise the host’s ability to contain localized infections and facilitate sepsis progression. With increasing diabetes prevalence, sepsis incidence in this group is rising., A survey in the United States revealed that in 2011 alone, the total hospital costs for patients with diabetes complicated by infections exceeded $48 billion. Among sepsis-related hospitalizations, approximately 25% of patients had diabetes, and the in-hospital mortality rate for these individuals exceeded 30%. Multiple large-scale studies have consistently indicated and called for an urgent need to establish an integrated diabetes-infection management model. Strengthening the timely identification of sepsis in diabetic patients and implementing effective interventions are critical to alleviating the burden of this disease and reducing mortality rates. Several studies on sepsis risk identification have been reported for specific diabetic subpopulations, such as those with diabetic foot infections or urinary tract infections. However, to the best of our knowledge, studies specifically exploring sepsis risk identification tools for the entire adult diabetic population (covering all types of acute infections) remain limited. Current diagnostics are inadequate: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria are too complex for primary care; other conventional scoring systems, such as the Systemic Inflammatory Response Syndrome (SIRS) criteria, the National Early Warning Score (NEWS), and the Quick Sequential Organ Failure Assessment (qSOFA), suffer from inadequate sensitivity, are compromised by poor specificity, or are inherently limited in their comprehensive exclusion capacity; and single biomarkers perform poorly. As noted above, chronic hyperglycemia, low-grade inflammation, immune dysregulation, and autonomic neuropathy collectively alter how diabetic patients respond to an infectious challenge, making generic tools such as SIRS, NEWS, and qSOFA potentially inadequate for this specific population. Therefore, shifting from a “one-size-fits-all” generic screening strategy to a paradigm that considers host-specific features may offer advantages for this population. Previous literature has suggested that certain host-specific factors may be associated with infection outcomes in diabetic populations, including hypoalbuminemia,,, gastrointestinal symptoms such as nausea or vomiting, fatigue,,, and the inflammatory biomarker procalcitonin., Therefore, this study aimed to develop a composite sepsis risk prediction model for diabetic patients with acute infections based on routinely available clinical signs, symptoms, and laboratory parameters. This retrospective study consecutively enrolled adult (≥18 years) non-pregnant and non-postpartum hospitalized patients with diabetes and concomitant acute infections who were admitted to Zhongshan Dongsheng Hospital in Zhongshan City, Guangdong Province, China, between July 2019 and March 2025. The cohort was subsequently stratified into sepsis and non-sepsis groups. The diagnosis of acute infection was established based on Chinese Expert Consensus on Early Prevention and Blocking of Sepsis, defined by the presence of at least two of the following three clinical criteria and concomitant receipt of antimicrobial therapy or microbiological testing: ① axillary temperature≥37.3°C or ≤36.1°C within 72 hours; ② abnormal white blood cell count (>9.5×10/L or <3.5×10/L); ③ C-reactive protein >4.0 mg/L. Sepsis was diagnosed using the Sepsis-3 criteria, defined as confirmed infection with a ΔSOFA score ≥2. Based on WHO criteria, diabetes was diagnosed by meeting any of: fasting plasma glucose ≥7.0 mmol/L; 2- hour postprandial plasma glucose ≥11.1 mmol/L; random plasma glucose ≥11.1 mmol/L; or HbA1c ≥6.5%; or a documented history of diabetes. In this study, the diagnostic criteria for acute infection were redefined according to the Chinese Expert Consensus as described above. By contrast, the diagnostic criteria for sepsis consistently followed the Sepsis-3 criteria, and the diagnostic criteria for diabetes consistently followed the WHO criteria throughout the entire study period. Inclusion criteria were hospitalised patients meeting the acute infection diagnosis. Exclusion criteria included repeated admissions of the same patient, transferred patients with a confirmed diagnosis from other hospitals, patients who received albumin(ALB) biological agent therapy prior to a confirmed diagnosis, patients missing key outcomes or essential records (eg, due to discharge against medical advice/transfer).