血红蛋白糖化指数与脓毒症患者短期和长期病死率的关系：基于MIMIC⁃Ⅳ数据库的分析

Association of hemoglobin glycation index with short⁃ and long⁃term mortality in patients with sepsis: An analysis based on the MIMIC⁃Ⅳ database

摘要

目的：探讨血红蛋白糖化指数（HGI）与脓毒症患者短期和长期病死率的关系。方法：基于MIMIC-Ⅳ 2.2数据库，纳入3 973例脓毒症患者。通过建立糖化血红蛋白（HbA1c）的线性回归模型计算HGI，并按五分位数（Q1~Q5）分组。采用Kaplan-Meier生存分析、多因素Logistic回归和限制性立方样条（RCS）分析评估其与28天及180天病死率的关系，并通过受试者工作特征（ROC）曲线比较HGI与传统血糖变异性指标的预测性能，最后进行亚组分析。结果：3 973例脓毒症患者28天和180天病死率分别为15.1%和22.0%。低HGI组（Q1、Q2）与高HGI组（Q5）生存率较低。多因素Logistic分析显示，与Q3组相比，Q1组28天和180天病死风险显著升高。HGI预测病死风险的ROC曲线下面积优于其他血糖变异性指标。RCS分析显示HGI与病死风险呈L形关系，亚组分析结果与前述一致。结论：低HGI与脓毒症患者短期和长期病死风险增加独立相关。

Abstract

Objective: To investigate the association between the hemoglobin glycation index (HGI) and short- and long-term mortality in patients with sepsis. Methods: A total of 3 973 septic patients from the MIMIC-Ⅳ 2.2 database were included. HGI was calculated as the difference between measured hemoglobin A1c (HbA1c) and the value predicted by a linear regression model based on fasting blood glucose. Patients were stratified into quintiles by HGI. Kaplan-Meier survival analysis, multivariable logistic regression, and restricted cubic spline (RCS) analysis were used to evaluate the relationship between HGI and 28-/180-day mortality. The predictive performance of HGI was compared with conventional glycemic variability indices using receiver operating characteristic (ROC) curves. Subgroup analysis was also performed. Results: The 28-day and 180-day mortality rates were 15.1% and 22.0%, respectively. Lower survival rates were observed in the low-HGI (Q1, Q2) and high-HGI (Q5) groups. Multivariable analysis showed that the Q1 group had significantly higher 28-day and 180-day mortality risks compared with the Q3 group. The area under the ROC curve of HGI outperformed other glycemic variability indicators. RCS analysis revealed an L-shaped relationship between HGI and mortality risk. Subgroup analyses yielded consistent results. Conclusion: Low HGI is independently associated with increased short- and long-term mortality in septic patients.

关键词

脓毒症 / 血红蛋白糖化指数 / MIMIC-Ⅳ数据库

Key words

Sepsis / Hemoglobin Glycation Index / MIMIC-Ⅳ Database

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基金资助

湖北省科技项目(220171849)

湖北省科技厅重点研发专项(2023BCB093)