The study, led by Benji Wang from the Department of Anesthesiology, Critical Care and Pain Medicine at The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang, China, was recently published in the Journal of Health, Population and Nutrition. It sheds new light on the importance of glycemic variation, particularly HGI, in influencing patient outcomes in the ICU.
Although glycemic variability has been increasingly acknowledged as a determinant of outcomes in critical care, the specific prognostic value of the hemoglobin glycation index has not been thoroughly explored before. This study aimed to bridge that gap by examining the relationship between HGI and all-cause mortality among ICU patients.
Using data from the MIMIC-IV database—a large, publicly available critical care database—the researchers conducted a retrospective cohort analysis involving 9,695 ICU patients. They assessed mortality outcomes at 30, 90, and 365 days, with in-hospital mortality as an additional outcome. Advanced statistical methods, including Kaplan-Meier survival analysis, Cox proportional hazards models, restricted cubic spline (RCS) modeling, and propensity score matching (PSM), were employed to ensure the validity and robustness of the findings.
The key findings of the study were as follows:
- Patients with lower HGI values (below -0.40) showed significantly higher mortality across all measured time points.
- A non-linear association between HGI and 30-day mortality was identified using restricted cubic spline (RCS) analysis.
- Higher HGI values were consistently linked to a reduced risk of death, with hazard ratios ranging from 0.43 to 0.76.
- These associations remained statistically significant even after adjusting for potential confounding variables.
- The results held true following propensity score matching, underscoring the robustness of the findings.
- Subgroup analyses confirmed that the association between HGI and mortality was consistent across different patient demographics and clinical characteristics.
- The findings suggest that HGI may serve as a broadly applicable prognostic marker in ICU settings.
According to the authors, the study is the first large-scale investigation to evaluate HGI as a mortality predictor among critically ill patients. The researchers propose that HGI could serve as an effective and easily accessible biomarker to guide individualized glycemic management and risk assessment in ICU settings.
The authors concluded, "The findings point toward a meaningful link between low HGI and increased mortality in critical care, reinforcing the potential utility of HGI in clinical decision-making and ICU patient stratification."
Reference:
Pan, L., Lu, F., Cheng, B. et al. Association between hemoglobin glycation index and mortality in critically ill patients: a retrospective cohort study. J Health Popul Nutr 44, 249 (2025). https://doi.org/10.1186/s41043-025-01008-9
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