〔Abstract〕 Objective To investigate the relationship between stress hyperglycemia ratio (SHR) and early neurological deterioration (END) in patients with acute ischemic stroke (AIS). Methods Clinical data and blood biochemical indexes of AIS patients attending three tertiary general hospitals in Shenzhen City from January 2023 to June 2023 were collected consecutively, and patients were divided into END and non-END groups according to the presence or absence of END. Multifactorial logistic regression was used to analyze whether influencing stress hyperglycemia ratio was a influence factor for END in AIS patients, and the predictive value of SHR for END was analyzed by using receiver operating characteristic (ROC) curve. Results A total of 277 patients were included, and 48 (17.33%) had END. The SHR level was lower in the non-END group than that in the END group [0.87 (0.15) vs 0.98 (0.27)，P = 0.001]. Multifactorial logistic regression analysis showed that patients in the high SHR group had an increased risk of END compared to the lower SHR group [adjusted OR = 4.487, 95% CI (1.167, 20.127), P = 0.030]. Subgroup analysis showed that the difference between the above results was statistically significant in the non-diabetic group [OR = 4.903, 95% CI (1.320, 18.206), P = 0.018], whereas the difference was not statistically significant in the diabetic group [OR = 0.793, 95% CI ( 0.056, 11.242), P = 0.084]. SHR predicted the END in patients with ischemic stroke had an area under the curve of 0.655 [95% CI (0.570, 0.740), P = 0.001], and Youden index for SHR was 0.275, with a sensitivity of 72.9 % and a specificity of 54.6 %. Conclusion Elevated HR is associated with an increased risk of END in patients with AIS and could predict the occurrence of END in patients with AIS.