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The relationship between hemoglobin glycation index and all-cause mortality in ill critically patients with heart
Yulong Wang1, Shanshan Tang1, Haokun Liu1
1Department of Cardiology, Tianjin Medical University General Hospital, Tianjin Medical University, 154, Anshan Road, Heping District, Tianjin, 300052, China.
Insights
Extremely low hemoglobin glycation index (HGI) in critically ill heart failure patients is linked to higher mortality. Lower HGI may indicate increased risk, suggesting its use as an additional prognostic tool.
Area of Science:
- Critical Care Medicine
- Cardiology
- Endocrinology
Background:
- Heart failure (HF) is a significant cause of mortality in critically ill patients requiring intensive care.
- The hemoglobin glycation index (HGI) may offer prognostic insights beyond traditional glycemic metrics in HF.
- HGI quantifies the difference between predicted and measured glycated hemoglobin (HbA1c).
Purpose of the Study:
- To investigate the association between HGI and mortality in critically ill heart failure patients.
- To determine if HGI can serve as an independent prognostic marker in this population.
- To explore the relationship between HGI levels and short-term (in-hospital, 30-day) and long-term (1-year) all-cause mortality.
Main Methods:
- Retrospective analysis of 8,098 adult HF patients from the MIMIC-IV database.
- Stratification into three groups based on HGI values (T1 ≤ -1.26, -1.26 < T2 < 1.74, T3 ≥ 1.74).
- Logistic regression and Cox proportional hazards models used to assess mortality risk, adjusting for covariates. Restricted cubic spline analysis explored non-linear relationships.
Main Results:
- Patients in the lowest HGI group (T1) exhibited significantly higher in-hospital, 30-day, and 1-year mortality rates compared to other groups (18.6% vs. 12.3% and 9.7%, p < 0.001).
- Each 1-unit increase in HGI was associated with a 12% reduced risk of in-hospital mortality (OR 0.88) and a 3% reduced risk of 1-year mortality (HR 0.97).
- Restricted cubic spline analysis revealed a J-shaped relationship between HGI and mortality, highlighting increased risk with very low HGI levels.
Conclusions:
- Extremely low HGI levels are associated with poorer short- and long-term survival in critically ill HF patients.
- HGI may function as an adjunctive tool for risk stratification in this patient cohort.
- Findings suggest closer monitoring and potential interventions for patients identified with markedly low HGI.
Background:
Heart failure (HF) is a major cause of mortality in critically ill patients and often requires intensive care. The hemoglobin glycation index (HGI), defined as the difference between predicted glycated hemoglobin (HbA1c) and measured HbA1c, may provide additional prognostic insights beyond traditional glycemic metrics.
Methods:
We conducted a retrospective analysis of 8,098 adult patients with HF from the MIMIC-IV database (2008-2022). All were first-time ICU admissions with available hematologic and metabolic data. Patients were stratified into three groups (T1 ≤ - 1.26, - 1.26 < T2 < 1.74, T3 ≥ 1.74) based on HGI. Baseline characteristics were recorded within 24 h of ICU admission, including demographic data, disease severity scores, comorbidities, and medication use. Logistic regression and Cox proportional hazards models assessed the associations between HGI and in-hospital, 30-day, and 1-year all-cause mortality, adjusting for age, sex, race, comorbidities, laboratory results, and relevant treatments. Restricted cubic spline (RCS) analysis was performed to examine potential non-linear relationships. We used sensitivity analyses to increase the confidence in our primary outcome.
Results:
Patients in the lowest HGI group (T1) had significantly higher in-hospital, 30-day, and 1-year mortality than those in the other two groups. Specifically, T1 showed an 18.6% in-hospital mortality rate, compared with 12.3% and 9.7% in T2 and T3, respectively (p < 0.001). Fully adjusted models revealed that each 1-unit increase in HGI was associated with an approximate 12% reduction in in-hospital mortality risk (OR = 0.88; 95%CI: 0.83-0.93), and an 3% decreased risk of 1-year all-cause mortality (HR 0.97; 95%CI0.94~1.00). RCS analysis indicated a J-shaped relationship between HGI and mortality, underscoring the heightened risk associated with very low HGI. We conducted sensitivity analyses by separately excluding missing data, diagnosed sepsis, and diagnosed hepatic impairment, consistent with the primary analysis.
Conclusions:
In critically ill HF patients, extremely low HGI levels correlate with poorer short- and long-term survival. These findings suggest that HGI could serve as an adjunct risk stratification tool, prompting closer monitoring and potential intervention in patients with markedly low HGI.
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