Hemoglobin A1C as a prognostic factor and the pre-diabetic paradox in patients admitted to a tertiary care medical center intensive cardiac care unit

Cardiovascular Diabetology

Dov Gavish¹  Feras Bayya¹  Michael Glikson¹  Nurit Algur¹  Kamal Hamayel¹  Nir Levi¹  Rivka Farkash¹  Gavriel Lichewitz¹  Hani Karameh¹  Fauzi Fadi Shaheen¹  Nimrod Perel¹  Yoed Steinmetz¹  Elad Asher¹  Mohammad Karmi¹  Tommer Maller¹  Louay Taha¹  Lior Lupu² 

[1] Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel);Department of Cardiology, Tel Aviv Medical Center (Affiliated to The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel);

关键词: Diabetes mellitus;    Prediabetes;    Hemoglobin A1c (HbA1c);    Acute cardiac care;    Prognosis;   

DOI  :  10.1186/s12933-022-01529-1

来源: DOAJ

【 摘 要 】

Abstract Background Hemoglobin A1C (HbA1c) is a form of glycated hemoglobin used to estimate glycemic control in diabetic patients. Data regarding the prognostic significance of HbA1c levels in contemporary intensive cardiac care unit (ICCU) patients is limited. Methods All patients admitted to the ICCU at a tertiary care medical center between January 1, 2020, and June 30, 2021, with documented admission HbA1c levels were included in the study. Patients were divided into 3 groups according to their HbA1c levels: < 5.7 g% [no diabetes mellitus (DM)], 5.7–6.4 g% (pre-DM), ≥ 6.5 g% (DM). Results A total of 1412 patients were included. Of them, 974 (69%) were male with a mean age of 67(± 15.7) years old. HbA1c level < 5.7 g% was found in 550 (39%) patients, 5.7–6.4 g% in 458 (32.4%) patients and ≥ 6.5 g% in 404 (28.6%) patients. Among patients who did not know they had DM, 81 (9.3%) patients had high HbA1c levels (≥ 6.5 g%) on admission. The crude mortality rate at follow-up (up to 1.5 years) was almost twice as high among patients with pre-DM and DM than in patients with no DM (10.6% vs. 5.4%, respectively, p = 0.01). Interestingly, although not statistically significant, the trend was that pre-DM patients had the strongest association with mortality rate [HR 1.83, (95% CI 0.936–3.588); p = 0.077]. Conclusions Although an HbA1c level of ≥ 5.7 g% (pre-DM & DM) is associated with a worse prognosis in patients admitted to ICCU, pre-DM patients, paradoxically, have the highest risk for short and long-term mortality rates.

【 授权许可】

Unknown