Association between hemoglobin glycation index and myocardial infarction in critically ill patients with diabetes mellitus: a retrospective study based on MIMIC-IV.

BACKGROUND

The hemoglobin glycation index (HGI), which quantifies the difference between observed and predicted hemoglobin A1c (HbA1c) levels, has been linked to adverse outcomes. However, its relationship with myocardial infarction (MI) in patients with diabetes mellitus (DM) remains unexplored. This study aimed to investigate the association between HGI and MI incidence in critically ill patients with diabetes mellitus (DM) using data from the MIMIC-IV database.

METHODS

Linear regression analysis of HbA1c and fasting blood glucose levels was conducted to calculate HGI. Subsequently, differences in MI incidence across HGI quartiles were assessed using the Kaplan-Meier survival analysis, with the log-rank test applied. Cox proportional hazards models and restricted cubic spline (RCS) analyses were conducted to estimate hazard ratios (HRs) for MI risk across HGI quartiles, with Q1 as the reference.

RESULTS

A total of 8,055 DM patients with an initial ICU admission exceeding 24 h were included, with 21.5% of them presenting MI. Compared to HGI Q1 (-3.81, -1.236), the risk of MI increased by 1.26 times in Q2 (HR: 1.26, 95% confidence interval [CI]: 1.10-1.45), 1.48 times in Q3 (HR: 1.48, 95% CI: 1.29-1.69), and 1.39 times in Q4 (HR: 1.39, 95% CI: 1.21-1.60). RCS analysis showed a nonlinear positive association between HGI and outcome events that remained consistent across different subgroups as the stratified analysis suggested.

CONCLUSION

A significant correlation was revealed between HGI and the risk of MI in patients with DM, especially among those with elevated HGI levels, suggesting that HGI may serve as a potential biomarker for assessing MI risk in this population.