Abstract Background The stress hyperglycemia ratio (SHR) has been established as a predictor of unfavorable outcomes across various diseases. However, its relationship with prognosis in patients with cardiogenic shock (CS) remains unclear. This study aims to investigate the association between SHR and outcomes in CS patients. Methods A total of 904 CS patients with their first ICU admission were included in this study, utilizing data from the American Medical Information Mart for Intensive Care (MIMIC-IV) database. The primary endpoints were all-cause mortality at 30 days and 360 days. Patients were stratified into three groups based on the tertiles of the SHR. Results The mean age of the cohort was 67.62 years, with 67.3% of participants being men. During the follow-up period, 221 patients (24.4%) died within 30 days, and 360 patients (39.8%) died within 360 days. The 30-day all-cause mortality rates were 16.9%, 22.3%, and 34.2% in the T1, T2, and T3 groups, respectively (p