Objective：To study the relationship between the stress hyperglycemia ratio（SHR）and patients with sepsis-related acute respiratory distress syndrome（ARDS）admitted to the intensive care unit（ICU）. Methods：A total of 375 patients with sepsis admitted to the ICU of the South Hospital of Oriental Hospital from October 2019 to February 2024 were retrospectively included. SHR was calculated based on the blood glucose and glycosylated hemoglobin（HbA1c）upon admission. The patients were divided into the ARDS group and the non -ARDS group according to whether ARDS occurred at the time of admission. The general clinical data of the two groups were compared. Multivariate logistic regression analysis was used to identify risk factors for the development of ARDS in sepsis patients. The predictive value of SHR for ARDS in sepsis was analyzed by receiver operating characteristic（ROC）curve. The performance of SHR was compared across different ARDS severity levels. 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 non-ARDS group，the ARDS group had lower P/F ratio，higer SOFA scores，SHR，admission blood glucose levels，and lactate levels，as well as longer duration of mechanical ventilation，vasopressor use，and ICU stay，with statistically significant differences. Multivariate logistic regression analysis showed that SOFA score（OR=1.307，95%CI：1.182-1.445）and SHR （OR=4.246，95% CI：1.940-9.296）were independent risk factors for ARDS（P ＜ 0.001）. ROC curve analysis showed that the area under the curve（AUC）value of SHR for predicting sepsis-associated ARDS was 0.682，with a sensitivity of 38.6% and a specificity of 91.4%. The combination of SHR and SOFA score had an AUC value of 0.791 for predicting sepsis-associated ARDS，with a sensitivity of 68.3% and a specificity of 80.2% . As the severity of sepsis - associated ARDS increased，SHR values were higher（P=0.002）. Conclusion：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. SHR can serve as a rapid warning indicator.