Glycated Hemoglobin (HbA1C): A Predictor of In-hospital Short Therm All Cause Mortality

Abstract

Background & objectives: HbA1c shows the mean glucose level in blood and is a biochemical parameter used in follow-up and diagnosis of diabetic patients. We aimed to investigate the association between HbA1c and in-hospital all cause mortality in diabetic patients who were admitted due to any diagnosis. Methods: 3207 diabetic patients included study who had been diagnosed with diabetes mellitus. Trauma patients, type 1 diabetes were excluded. Patients’ age, gender, admission diagnosis, duration of hospitalization, whether they died in-hospital, laboratory parameters and HbA1c levels were recorded. Results: The mean age of patients was 50.53±17 years with 59.7% (n:1913) being females. Patients who died in hospital had higher HbA1c, age, BUN (blood urea nitrogen), creatine and uric acid levels according to the Univariate analysis (p=0.000, p=0.000; p=0.004, p=0.04, p=0.03; respectively). In the model 1 in multivariate analysis, there was a significant correlation between HbA1c level and in-hospital mortality (uncorrected OR: 1.216, 95% CI 1.116-1.326, p<0.001). In the model 2, the significant correlation between HbA1c level and in hospital mortality continued when corrected with age and gender (corrected OR: 1.150, 95% CI 1.046-1.265, p:0.004). In the model 3, which was created with covariates that were found significant in the univariate analysis, the correlation between HbA1c level and in hospital mortality still continued (corrected OR: 1.151, 95% CI 1.041-1.271, p:0.006). Interpretation & conclusions: There was a positive correlation between in hospital all cause mortality and HbA1c level in diabetic patients who had admitted any diagnosis. HbA1c level predict in hospital short term all cause mortality.

Keywords

• Tip 2 Diabetes Mellitus,HbA1c,In hospital mortality

Kaynakça

1. 1. Skriver MV, Sandbæk A, Kristensen JK, H Stovring. Relationship of HbA1c variability, absolute changes in HbA1c, and all-cause mortality in type 2 diabetes: a Danish population-based prospectiveobservational study. BMJ Open Diabetes Research and Care 2015;2: 1-8.
2. 2. Wolsk E, Claggett B, Pfeffer MA, Diaz R, Dickstein K, Gerstein HC, et al. Role of B-Type Natriuretic Peptide and N-Terminal Prohormone BNP as Predictors of Cardiovascular Morbidity and Mortality in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus J Am Heart Assoc 2017; 29:1-11.
3. 3. Nilsson E, Carrero JJ, Heimbürger O, Hellberg O, Lindholm B, Stenvinkel P. A cohort study of insulin-like growth factor 1 and mortality in haemodialysis patients. Clinical Kidney Journal 2016; 9: 148–152.
4. 4. Thomas L. Christoph MN, Hans R. Glycohemoglobins. Clinical Laboratory Diagnostics 1998;142-148.
5. 5. Rahbar S. An abnormal hemoglobin in red cells of diabetics. Clin Chem 1968;22:296-308.
6. 6. Krishnamurti U, Steeffes MW. Glycohemoglobin: A primary predictor of the development or reversal of complications of diabetes mellitus. Clin Chem 2001;47:1157-1165.
7. 7. Saudek CD, Rastogi R, Derr RL. Assesment of glycemia in diabetes mellitus: Hemoglobin A1c. J Assoc Physicians India 2005;53:299-304.
8. 8. Zhong GC, Ye1 MX, Cheng JH, Zhao Y, Gong JP. HbA1c and Risks of All-Cause and Cause-Specific Death in Subjects without Known Diabetes: A Dose-Response Meta-Analysis of Prospective Cohort Studies. Scientific Reports 2016;6:24071.

9. 9. Perry RC, Shankar RR, Fineberg N, McGill J, Baron AD. HbA1c measurement improves the detection of type 2 diabetes in high risk individuals with nondiagnostic levels of fasting plasma glucose. Diabetes Care 2001 24:465-471.
10. 10. Li W, Katzmarzyk PT, Horswel R, Wang Y, Jhonson J, Hu G. HbA1c and all-cause mortality risk among patients with type 2 diabetes. Int J Cardiol 2016;202:490–496.
11. 11. Bancks MP, Odegaard AO, Pankow JS, Khon WP, Yuan JM, Gross MD, et al. Glycated hemoglobin and all-cause and cause-specific mortality in Singaporean Chinese without diagnosed diabetes: The Singapore Chinese Health Study. Diabetes Care 2014;37:3180–3187.
12. 12. Sakuraı M, Saıtoh S, Mıura K, Nakagawa H, Ohnıshı H, Akasaka H, et al. HbA1c and the risks for all-cause and cardiovascular mortality in the general Japanese population: NIPPON DATA 90. Diabetes Care 2013; 36: 3759–3765. 13. Zhang Y, Hu G, Yuan Z, Chen L. Glycosylated hemoglobin in relationship to cardiovascular outcomes and death in patients with type 2 diabetes: a systematic review and meta-analysis. PLoS One 2012;7:1-11.
13. 14. Lionel KR, John J, Sen N. Glycated hemoglobin A: A predictor of outcome in trauma admissions to intensive care unit. Indian J Crit Care Med 2014;18:21‑5.
14. 15. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008; 359:1577–89.
15. 16. Gerstein HC, Miller ME, Byington RP, Goff DC, Bigger JT, Buse JB, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358:2545–59.
16. 17. Liberty IF, Freha NA, Baumfeld Y, Codish S, Schlaeffer F, Novack V. Prognostic value of glycated hemoglobin for one Year mortality Following hospitalization in the internal medicine ward. IMAJ 2015; 17: 277-81.
17. 18. Cavero-Redondo I, Peleteiro B, Álvarez-Bueno C, Rodriguez AF, Martinez VV. Glycated haemoglobin A1c as a risk factor of cardiovascular outcomes and all-cause mortality in diabetic and nondiabetic populations: a systematic review and meta-analysis. BMJ 2017;7:e015949.
18. 19. Li W, Katzmarzyk PT, Horswell R, Wang Y, Johnson J, Hu G. HbA1c and all-cause mortality risk among patients with type 2 diabetes Int J Cardiol 2016;202: 490–496.
19. 20. Nicholas J, Charlton J, Dregan A, Gulliford MC. Recent HbA1c Values and Mortality Risk in Type 2 Diabetes. Population-Based Case-Control Study. PLoS One 2013 5;8:1-7.
20. 21. Skriver MV, Sandbæk A, Kristensen JK, Stovring H. Relationship of HbA1c variability, absolute changes in HbA1c, and all-cause mortality in type 2 diabetes: a Danish population-based prospective observational study BMJ Open Diabetes Research and Care 2015;2:1-8.
21. 22. Sluik D, Boeing H, Montonen J, Kaaks R, Lukanova A, Sandbaek A, et al HbA1c Measured in Stored Erythrocytes Is Positively Linearly Associated with Mortality in Individuals with Diabetes Mellitus. PLoS One 2012;7:1-9.
22. 23. He L, Zhang S, Liu X, Jiang Y, Wang X, Yang Z. HbA1c-Based Score Model for Predicting Death Risk in Patients with Hepatocellular Carcinoma and Type 2 Diabetes Mellitus. J Diabetes Res 2017; 1-7.
23. 24. Huang Y, Zheng H, Chen P, Yang J, Lin S, Liu T et al. An Elevated HbA1c Level Is Associated With Short-Term Adverse Outcomes in Patients With Gastrointestinal Cancer and Type 2 Diabetes Mellitus. J Clin Med Res 2017;9:303-309.
24. 25. Chen Y, Lin Y, Chong E, Chen PC, Chao TF, Chen SA, et al. The Impact of Diabetes Mellitus and Corresponding HbA1c Levels on the Future Risks of Cardiovascular Disease and Mortality: A Representative Cohort Study in Taiwan. PLoS One 2015;13:1-12.
25. 26. Butkowski EG, Jelinek HF. Hyperglycaemia, oxidative stress and inflammatory markers. Redox Report 2017;22:257-264.
26. 27. Kurup SB, Mini S. Averrhoa bilimbi fruits attenuate hyperglycemia-mediated oxidative stress in streptozotocin-induced diabetic rats Journal of food and drug analysis 2017;25:360-368.
27. 28. Esposito K, Nappo F, Marfella R, Giugliano G, Giugliano F, Ciotola M, et al. Inflammatory Cytokine Concentrations Are Acutely Increased by Hyperglycemia in Humans Role of Oxidative Stress. Circulation 2002;106:2067-2072. 29. Mahmoodpoor A, Hamishehkar H, Shadvar K, Beigmohammadi M, Iranpour A, Sanaie S. Relationship between glycated hemoglobin, Intensive Care Unit admission blood sugar and glucose control with ICU mortality in critically ill patients. Indian Journal of Critical Care Medicine 2016;20: 67- 71.