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. 2025 Jul 12;44(1):249.
doi: 10.1186/s41043-025-01008-9.

Association between hemoglobin glycation index and mortality in critically ill patients: a retrospective cohort study

Liwei Pan  1 , Fengfeng Lu  1 , Bihuan Cheng  1 , Wenwu Zhang  1 , Benji Wang  2
Affiliations

Association between hemoglobin glycation index and mortality in critically ill patients: a retrospective cohort study

Liwei Pan et al. J Health Popul Nutr. .

Abstract

Background: Glycemic variability is increasingly recognized as a critical factor influencing outcomes in intensive care, yet its prognostic role remains unclear. The Hemoglobin Glycation Index (HGI), which reflects individual glycemic variation, has not been thoroughly studied in critically ill populations.

Aim: To evaluate the association between HGI and all-cause mortality in critically ill patients using data from a large intensive care unit (ICU) cohort.

Methods: We conducted a retrospective cohort study using the MIMIC-IV database. The primary outcomes were 30-, 90-, and 365-day all-cause mortality; in-hospital mortality was secondary. Kaplan-Meier analysis, Cox regression, and restricted cubic spline (RCS) modeling were used to assess mortality risk across HGI levels. Propensity score matching (PSM) and subgroup analyses were performed to ensure robustness.

Results: Among 9,695 patients, those with low HGI (< - 0.40) had significantly higher mortality (P < 0.001). RCS analysis showed a nonlinear association between HGI and 30-day mortality. Higher HGI values were independently associated with reduced risk of death at all time points, with hazard ratios ranging from 0.43 to 0.76 (P < 0.001). These associations persisted after multivariable adjustment and PSM. Subgroup analyses showed consistent results across patient characteristics.

Conclusions: Lower HGI values are associated with increased short- and long-term mortality in critically ill patients. HGI may serve as a valuable prognostic biomarker for risk stratification in ICU settings.

Keywords: Hemoglobin glycation index; Intensive care unit; Mortality; Restricted cubic spline; Retrospective cohort study.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: Ethical approval for the MIMIC-IV database was granted by the institutional review boards at Beth Israel Deaconess Medical Center and the Massachusetts Institute of Technology. Given the absence of protected health information in the database, the institutional review board approval included a waiver of the informed consent requirement.

Figures

Fig. 1
Fig. 1
The correlation between HGI and HbA1c
Fig. 2
Fig. 2
Kaplan-Meier survival curves for all-cause mortality: (a) comparing mortality at 30 days; (b) comparing mortality at 90 days; (c) comparing mortality at 365 days across groups
Fig. 3
Fig. 3
HGI and 30-day all-cause mortality HR in critically ill patients
See this image and copyright information in PMC

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