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. 2023 Mar 24:10:998477.
doi: 10.3389/fmed.2023.998477. eCollection 2023.

Improving the accuracy of revised cardiac risk index with HbA1C: Hemoglobin ratio (HH ratio) - A retrospective cohort study

Yuhe Ke  1 , Nicholas Brian Shannon  2 , Hairil Rizal Abdullah  1
Affiliations

Improving the accuracy of revised cardiac risk index with HbA1C: Hemoglobin ratio (HH ratio) - A retrospective cohort study

Yuhe Ke et al. Front Med (Lausanne). .

Abstract

Background: The current Lee's Revised cardiac risk index (RCRI) was created in 1999. Validation studies have found RCRI to be only moderately discriminant. The "Diabetes Mellitus on insulin" component of the score does not accurately reflect the severity of the disease. A previously studied HbA1C:Hemoglobin ratio shows an improved association with outcomes than individual components alone.

Study design: A retrospective cohort study was performed in diabetic patients undergoing non-cardiac surgery. Ethics approval was obtained. The study compares the predictive value of RCRI and substitution of the "DM on insulin" component with HH ratio for 30- and 90-day mortality, and postoperative acute myocardial injury (AMI) and acute kidney injury (AKI).

Results: A total of 20,099 adult patients were included in the final analysis. The incidence of 30- and 90-day mortality was at 4.2 and 6.5%, respectively. Substitution of HH ratio in RCRI resulted in 687 more patients being in the moderate to high-risk category. The substituted HH-RCRI score had better prediction for 30-day (AUC 0.66 vs. 0.69, p < 0.001) and 90-day mortality (AUC 0.67 vs. 0.70, p < 0.001), and postoperative AMI (AUC 0.69 vs. 0.71, p < 0.001) and AKI (AUC 0.57 vs. 0.62, p < 0.001).

Conclusion: Although currently not an universal practice, substitution of "DM on insulin" with HbA1C:Hemoglobin ratio in RCRI score improves the accuracy of the RCRI risk prediction model in diabetic patients going for non-cardiac surgery.

Keywords: HH ratio; HbA1c (glycated hemoglobin test); diabetes mellitus; revised cardiac risk index (RCRI); risk model.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
CONSORT diagram. A final number of 20,099 patients were included in the analysis.
FIGURE 2
FIGURE 2
Barchart of patients in moderate + high-risk category according to RCRI (light blue) and RCRI-HH (dark blue).
FIGURE 3
FIGURE 3
Pictorial representation of HH-RCRI score in identifying an additional 687 patients in the intermediate + high risk category.
FIGURE 4
FIGURE 4
Receiver operator curve (ROC) of substituted HH-RCRI score (Yellow), RCRI score only (Purple), HbA1C:Hemoglobin ratio (Green), “DM on insulin” (Red) and preoperative HbA1C (Blue) in the prediction of postoperative acute myocardial injury (AMI).
FIGURE 5
FIGURE 5
Heatmap of preoperative HbA1C and HbA1C:Hemoglobin (HH) ratio on likelihood of 90-day mortality (Higher likelihood is represented by darker color). Preoperative HbA1C cut-off of 7.0% (horizontal line) and HH ratio cut-off of 0.7 (vertical lines) is indicated.
See this image and copyright information in PMC

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