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BackgroundAlthough hyperglycemia is a well-known prognostic factor in diabetic stroke patients, its impact on outcomes in individuals without documented diabetes remains insufficiently explored. This study aimed to investigate the relationship between stress-induced hyperglycemia and both short- and long-term mortality, as well as impaired consciousness, in patients without documented diabetes with ischemic or hemorrhagic stroke.MethodsA retrospective cohort study was conducted using the MIMIC-IV (v3.1) database, including ICU-admitted patients without documented diabetes (ischemic or hemorrhagic stroke identified via ICD-9/10 codes). Exclusion criteria were: age ResultsFollowing PSM, 1,170 matched pairs were analyzed. In patients with hemorrhagic stroke (HS), stress hyperglycemia was associated with an increased 1-year mortality risk (HR = 0.71, p = 0.029). Among ischemic stroke (IS) patients, hyperglycemia independently predicted both in-hospital and 1-year mortality (HR range: 0.65–0.79, p ConclusionStress hyperglycemia independently predicts poor outcomes in stroke without documented diabetes, especially in ischemic subtypes. These findings highlight the importance of early glycemic assessment and tailored management strategies. Further research is warranted to validate causal mechanisms. In hemorrhagic stroke, its impact appears more delayed, affecting long-term prognosis. These findings support the need for early recognition and tailored glycemic control strategies based on stroke subtype.