ICU 中血红蛋白 A1c 与全因死亡率的关系：基于 MIMIC-IV 2.0 的横断面研究。
The association between hemoglobin A1c and all-cause mortality in the ICU: A cross-section study based on MIMIC-IV 2.0.
机构信息
Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, China.
Department of Gastrointestinal Surgery, Third Xiangya Hospital, Central South University, Changsha, China.
出版信息
Front Endocrinol (Lausanne). 2023 Feb 15;14:1124342. doi: 10.3389/fendo.2023.1124342. eCollection 2023.
BACKGROUND
Hyperglycemia has been reported to be associated with the outcomes of patients in the intensive care unit (ICU). However, the relationship between hemoglobin A1c (HbA1c) and long-term or short-term mortality in the ICU is still unknown. This study used the Medical Information Mart for Intensive Care (MIMIC)-IV database to investigate the relationship between HbA1c and long-term or short-term mortality among ICU patients without a diabetes diagnosis.
METHODS
A total of 3,154 critically ill patients without a diabetes diagnosis who had HbA1c measurements were extracted and analyzed from the MIMIC-IV. The primary outcome was 1-year mortality, while the secondary outcomes were 30-day mortality and 90-day mortality after ICU discharge. HbA1c levels were classified into four levels according to three HbA1c values (5.0%, 5.7%, and 6.5%). The Cox regression model was used to investigate the relationship between the highest HbA1c measurement and mortality. Finally, this correlation was validated using the XGBoost machine learning model and Cox regression after propensity score matching (PSM).
RESULTS
The study eventually included 3,154 critically ill patients without diabetes who had HbA1c measurements in the database. HbA1c levels of below 5.0% or above 6.5% were significantly associated with 1-year mortality after adjusting for covariates in Cox regression (HR: 1.37; 95% CI: 1.02-1.84 or HR: 1.62; 95% CI: 1.20-2.18). In addition, HbA1c 6.5% was linked to 30-day mortality (HR: 1.81; 95% CI: 1.21-2.71) and 90-day mortality (HR: 1.62; 95% CI: 1.14-2.29). The restricted cubic spline demonstrated a U-shaped relationship between HbA1c levels and 1-year mortality. The AUCs of the training and testing datasets in the XGBoost model were 0.928 and 0.826, respectively, while the SHAP plot revealed that HbA1c was somewhat important for the 1-year mortality. Higher HbA1c levels in Cox regression were still significantly associated with 1-year mortality after PSM for other factors.
CONCLUSIONS
The 1-year mortality, 30-day mortality, and 90-day mortality rates for critically ill patients after discharge from ICU are significantly associated with HbA1c. HbA1c < 5.0% and ≥6.5% would increase 30-day, 90-day, and 1-year mortality, while levels between 5.0% and 6.5% of HbA1c did not significantly affect these outcomes.
背景
已有研究报道高血糖与重症监护病房（ICU）患者的预后相关。然而，血红蛋白 A1c（HbA1c）与 ICU 患者的短期或长期死亡率之间的关系仍不清楚。本研究使用医疗信息集市重症监护（MIMIC-IV）数据库，调查了无糖尿病诊断的 ICU 患者 HbA1c 与长期或短期死亡率之间的关系。
方法
从 MIMIC-IV 数据库中提取并分析了 3154 名无糖尿病诊断且有 HbA1c 测量值的危重症患者。主要结局为 1 年死亡率，次要结局为 ICU 出院后 30 天和 90 天的死亡率。根据三个 HbA1c 值（5.0%、5.7%和 6.5%）将 HbA1c 水平分为四个水平。使用 Cox 回归模型来研究最高 HbA1c 测量值与死亡率之间的关系。最后，使用 XGBoost 机器学习模型和倾向评分匹配（PSM）后的 Cox 回归对这种相关性进行了验证。
结果
本研究最终纳入了数据库中 3154 名无糖尿病且有 HbA1c 测量值的危重症患者。Cox 回归校正混杂因素后，HbA1c 水平低于 5.0%或高于 6.5%与 1 年死亡率显著相关（HR：1.37；95%CI：1.02-1.84 或 HR：1.62；95%CI：1.20-2.18）。此外，HbA1c 6.5%与 30 天死亡率（HR：1.81；95%CI：1.21-2.71）和 90 天死亡率（HR：1.62；95%CI：1.14-2.29）相关。受限立方样条分析显示，HbA1c 水平与 1 年死亡率之间呈 U 型关系。XGBoost 模型中训练数据集和测试数据集的 AUC 分别为 0.928 和 0.826，SHAP 图显示 HbA1c 对 1 年死亡率有一定影响。校正其他因素后，Cox 回归中的较高 HbA1c 水平仍与 1 年死亡率显著相关。
结论
ICU 出院后危重症患者的 1 年死亡率、30 天死亡率和 90 天死亡率与 HbA1c 显著相关。HbA1c < 5.0%和≥6.5%会增加 30 天、90 天和 1 年的死亡率，而 HbA1c 水平在 5.0%至 6.5%之间则不会显著影响这些结果。
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