Objective：We aim to study the relationship between stress hyperglycemia ratio (SHR) and patients with sepsis-related acute respiratory distress syndrome (ARDS) in intensive care unit (ICU).Methods：This is a retrospective observational study involving 375 patients with sepsis hospitalized in the ICU of the South Hospital of Oriental Hospital from October 2019 to February 2024. Based on the blood glucose and glycosylated hemoglobin (HbAlc) immediately after admission, SHR= immediate admission blood glucose (mmol/L) / 1.59×HbAlc(glycosylated hemoglobin)-2.59 was calculated. Sepsis patients were divided into ARDS group and non-ARDS group according to whether ARDS occurred at admission. The general clinical data of the two groups were compared. Multivariate Logistic regression analysis was used to screen the risk factors of ARDS in sepsis. The predictive value of SHR for ARDS in sepsis was analyzed by receiver operating curve (ROC). According to the different degree of ARDS grading, the performance of SHR in different ARDS grading was compared.Results:In this study, there were 293 patients with sepsis-related ARDS (78.1%), 128 patients with mild ARDS (44.7%), 116 patients with moderate ARDS (39.6%) and 49 patients with severe ARDS (16.7%). Compared with the patients without sepsis-related ARDS, the P/F index and SOFA score in the patients with sepsis-related ARDS were lower. Multivariate Logistic regression analysis showed that SOFA score and SHR were independent risk factors for ARDS (OR=1.307, 4.246, P < 0.001). 〔ROC curve analysis showed that SHR had a sensitivity of 38.6% and a specificity of 91.4% in predicting the occurrence of sepsis-related ARDS (AUC was 0.682). SHR combined with SOFA score can predict the occurrence of sepsis-related ARDS [the area under 〔ROC curve (AUC) is 0.791], with a sensitivity of 68.3% and a specificity of 80.2%. With the severity of ARDS associated with sepsis, the value of SHR increased (P = 0.002 < 0.05)..Conclusions:High SHR value is a risk factor for ARDS in sepsis patients; The level of SHR is related to the occurrence and severity of ARDS caused by sepsis and has predictive value. It can be used as one of the indicators of rapid warning.