Elevated Hemoglobin A1c and the Risk of Developing ARDS in Two Cohort Studies
Avery M Bogart1,2, Christine R Lopez3, Sarah N Obeidalla4
1Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN.
CHEST Critical Care
|October 18, 2024
Summary
Inadequate glycemic control, indicated by elevated hemoglobin A1c (HbA1c), may increase the risk of developing acute respiratory distress syndrome (ARDS), even without a diabetes diagnosis. Further research is needed to confirm this association.
Area of Science:
- Critical care medicine
- Pulmonology
- Endocrinology
Background:
- The contribution of pre-existing conditions like diabetes to acute respiratory distress syndrome (ARDS) risk is unclear.
- Previous studies on diabetes and ARDS have produced conflicting results.
Purpose of the Study:
- To investigate if hemoglobin A1c (HbA1c) levels, as a marker of long-term glycemic control, clarify the association between diabetes and ARDS risk.
- To determine if HbA1c is a better predictor of ARDS than a formal diabetes diagnosis.
Main Methods:
- Analysis of data from two prospective observational cohorts (VALID and EARLI) of critically ill adults.
- Examined the association between HbA1c categories and ARDS development in at-risk patients.
- Included patients with an HbA1c measurement within 180 days before or 14 days after enrollment.
Main Results:
- A formal diabetes diagnosis did not significantly correlate with increased ARDS risk in either cohort.
- Patients with inadequate glycemic control (elevated HbA1c) showed a significantly higher risk of ARDS in the VALID cohort (P = .0073).
- This association was confirmed in multivariable analysis and when combining both cohorts, suggesting inadequate glycemic control as a potential ARDS risk factor.
Conclusions:
- Elevated HbA1c may be an independent risk factor for ARDS, irrespective of a diabetes diagnosis.
- Inadequate glycemic control could represent an unrecognized risk factor for ARDS.
- Prospective validation studies are necessary to confirm these findings.
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