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ObjectivesDiabetes mellitus (DM) is a common comorbidity in intensive care unit (ICU) patients. The Braden skin score (BSS) has increasingly been recognized as an indicator of patient frailty. However, the association between the BSS and clinical outcomes in critically ill diabetic patients remains unclear. This study aimed to investigate the relationship between the BSS and clinical outcomes in diabetic patients in ICU settings.MethodsA retrospective cohort of diabetic patients with measured BSS was identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The primary outcomes included mortality at 30, 60, and 90 days. The association between BSS and survival outcomes was evaluated using time-dependent Cox proportional hazards model. Further validation was conducted through Kaplan-Meier survival analysis, restricted cubic spline fitting, and subgroup analyses.ResultsA total of 20,590 patients were included in this study, those with higher BSS had a 14% decreased risk of 30-day mortality (HR: 0.86, 95% CI: 0.84-0.87, p < .01). Based on cutoff values of 13, patients were categorized into two risk groups. After adjusting for covariates, time-dependent Cox proportional hazards model indicated that the high-risk group exhibited a significantly increased 30-day all-cause mortality compared with the low-risk groups (HR: 1.76, 95% CI: 1.62-1.91, p < .01). Kaplan-Meier curves consistently demonstrated poorer survival across all time points in the high-risk group. Subgroup analysis further indicated that the association between BSS and mortality was particularly pronounced in patients with cerebrovascular disease.ConclusionsA low BSS was independently linked to higher mortality among critically ill patients with diabetes, especially in those with concomitant cerebrovascular diseases. These results support the potential utility of BSS as a prognostic indicator in this population. Further validation through larger prospective studies remains necessary.