To explore the relationship between multiple glycemic markers and all-cause mortality in patients with severe atrial
Aifeng He1,2, Hongjing Li3, Shengkai Yang1
1Binhai County People's Hospital, Kangda College of Nanjing Medical University, Yancheng, Jiangsu Province, China.
Insights
Glycemic variability (GV) is the primary predictor of mortality in critically ill patients with atrial fibrillation (AF). Managing GV and hyperglycemia is crucial for improving outcomes in these high-risk patients.
Area of Science:
- Critical Care Medicine
- Cardiology
- Endocrinology
Background:
- Atrial fibrillation (AF) is a common arrhythmia associated with increased morbidity and mortality in critically ill patients.
- Effective management of glycemic control indicators is essential for improving clinical outcomes in intensive care unit (ICU) settings.
Purpose of the Study:
- To investigate the associations between glycemic control indicators (hemoglobin A1c (HbA1c), hemoglobin glycation index (HGI), stress hyperglycemia ratio (SHR), and glycemic variability (GV)) and clinical outcomes in AF patients admitted to the ICU.
- To identify the strongest predictor of mortality among these glycemic control indicators in critically ill AF patients.
Main Methods:
- Retrospective analysis of data from the MIMIC-IV database and a Chinese hospital cohort.
- Inclusion of 952 AF patients from MIMIC-IV and 286 from the Chinese hospital for external validation.
- Statistical analyses included Kaplan-Meier curves, Cox regression, smooth fitting, sensitivity analysis, and weighted quantile sum (WQS) modeling.
Main Results:
- Glycemic variability (GV) was the strongest predictor of both ICU and 28-day post-ICU mortality (AUCs 0.620 and 0.607, respectively).
- Higher GV levels correlated with increased mortality risk; GV was the dominant factor influencing outcomes.
- Hemoglobin glycation index (HGI) and stress hyperglycemia ratio (SHR) also showed significant associations with mortality, with lower HGI linked to increased ICU mortality risk.
Conclusions:
- Glycemic control, particularly managing glycemic variability, is critical for improving outcomes in critically ill AF patients.
- Targeted interventions for hyperglycemia and its variability are needed.
- Further research should explore underlying mechanisms and the impact of glycemic management strategies.
Abstract:
Atrial fibrillation is a common cardiac arrhythmia that significantly increases the risk of morbidity and mortality in critically ill patients. This study aimed to investigate the associations between glycemic control indicators-hemoglobin A1c (HbA1c), hemoglobin glycation index (HGI), stress hyperglycemia ratio (SHR), and glycemic variability (GV)-and clinical outcomes in AF patients admitted to intensive care unit (ICU). We conducted a retrospective analysis utilizing data from the Critical Care Medicine Information Marketplace (MIMIC)-IV database and a cohort from Binhai County People's Hospital, comprising patients with AF. Key endpoints included all-cause mortality during ICU stay and at 28-day post-ICU. Statistical analyses involved Kaplan-Meier survival curves, univariable and multivariable Cox regression models, smooth fitting curve, sensitivity analysis and weighted quantile sum (WQS) modeling. Finally, a total of 952 AF patients from MIMIC-IV database and 286 patients of Binhai People's Hospital due to AF were included for external verification. The results indicated that GV was the strongest predictor of mortality, with higher levels correlating with an increased risk of death (area under curve (AUC) = 0.620 for ICU mortality; AUC = 0.607 for 28-day post-ICU mortality). HGI and SHR also demonstrated significant associations with mortality outcomes, particularly in specific subgroups. Notably, lower HGI levels were linked to increased ICU mortality risk (log-rank P = 0.006). GV was the dominant factor in both outcomes and had a higher weight for death at 28 days after ICU (62.7% for ICU mortality vs. 47.3% for 28-day post-ICU mortality). These findings suggest that glycemic control is critical for improving outcomes in critically ill AF patients, highlighting the need for targeted interventions in managing hyperglycemia and its variability. Future studies should explore the mechanisms underlying these associations and assess the impact of glycemic management strategies on patient outcomes.
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