Hemoglobin glycation index may contextualize the association between time-varying stress hyperglycemia ratio and mortality in critically ill patients with heart failure: a multicenter retrospective cohort study
Authors' conclusion
Time-varying SHR was independently associated with mortality in critically ill patients with heart failure, with a numerical tendency toward stronger associations among patients with low HGI phenotype. These hypothesis-generating findings suggest that dynamic SHR assessment combined with HGI-informed interpretation may potentially aid individualized glycemic risk assessment in this population.
Study context
- Population
- Adult critically ill patients with HF from 3 ICU databases
- Participants
- 2,488 patients3 databases
- Exposure
- Time-varying stress hyperglycemia ratio (SHR) and mortality across hemoglobin glycation index (HGI) tertiles
- MIMIC-III-CareVuen = 307
- MIMIC-IV v3.1n = 1,654
- NWICU v0.1.0n = 527
- Outcome
- Mortality (28-day and in-hospital) associated with time-varying SHR across HGI tertiles
Methodological detailstime-varying exposure, extended Cox proportional hazards models
- Time-varying exposure
- Extended Cox proportional hazards models
Main finding
As reported in the abstract
MIMIC-III: HR per 0.1-unit SHR increase (95% CI 1.06-1.21)
HR 1.13
MIMIC-IV: HR per 0.1-unit SHR increase (95% CI 1.07-1.13); both P < 0.001
HR 1.10
Observational data: associations, not effects.
Further findings
HGI-stratified 28-day mortality, MIMIC-IV (HR per 0.1-unit SHR)
- HGI T1 HR
- 1.13 (1.08-1.17) (95% CI)
- HGI T3 HR
- 1.06 (1.01-1.12) (95% CI)
- SHR × HGI interactions not significant in individual databases
- Numerical gradient
Dose-response (restricted cubic splines)
- J-shaped curves in larger analyses; significant nonlinearity in MIMIC-IV and pooled in-hospital mortality cohort
Incremental discrimination of mean SHR added to clinical models
- ΔAUC
- 0.029-0.032, P ≤ 0.019
Subgroup heterogeneity
- Significant effect heterogeneity by age, sex and Charlson index
- all P-interaction < 0.05
Sensitivity analyses
- Eight sensitivity analyses corroborated robustness
Original publication
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