The association between serum HbA1c and infected pancreatic necrosis in acute necrotizing pancreatitis

Given the evidence that poor glycemic control is associated with immunological dysfunction, serum glycosylated hemoglobin A1c (HbA1c), as a useful indicator reflecting blood glucose homeostasis, has potential to predict infectious complications. In this study, we aimed to explore the association between poor glycemic control (HbA1c ≥ 6.5 as an indicator) and infected pancreatic necrosis (IPN) in patients with acute necrotizing pancreatitis (ANP).

This is a secondary analysis of pooled data from the TRACE trial and a retrospective single-center cohort, involving ANP patients admitted within 72 h after onset of abdominal pain between March 2017 and October 2022. Patients had no HbA1c data at enrollment/admission were excluded. The Multivariable Cox proportional hazards regression (MCPHR) model was used to assess the association between poor glycemic control and 90-day IPN. Mediation analyses were used to define the relationships between the independent variables and 90-day IPN.

A total of 153 patients were enrolled, of whom 20.3% (31/153) patients developed IPN within 90 days. Most patients with IPN had HbA1c ≥ 6.5% at admission (25/31, 80.6%), compared to 38.5% (47/122) in the non-IPN patients. In the MCPHR model, HbA1c ≥ 6.5% [HR (95%CI) = 4.10 (1.42-11.90); p = 0.009], SOFA score on admission [HR (95%CI) = 1.47 (1.26-1.70); p < 0.001] and pancreatic necrosis extent > 50% [HR (95%CI) = 3.15 (1.06-9.35); p = 0.039] were independent risk factors for 90-day IPN. In addition, patients with HbA1c ≥ 6.5% experienced a higher incidence of hyperglycemia during the first week of enrollment [RR (95%CI) = 9.19 (4.23-19.95); p < 0.001]. Mediation analyses showed that the presence of hyperglycemia completely mediated the association between HbA1c ≥ 6.5% and 90-day IPN.

Among ANP patients, HbA1c ≥ 6.5% was associated with the development of IPN. The mediation effect of hyperglycemia may explain it.