血红蛋白糖化指数与脓毒症患者不良预后的关系

袁红秀; 唐发娟; 李熙鸿

doi:10.13201/j.issn.1009-5918.2025.01.006

血红蛋白糖化指数与脓毒症患者不良预后的关系

- 1.
  四川大学出生缺陷与相关妇儿疾病教育部重点实验室(成都，610041)
- 2.
  四川大学华西第二医院儿科
- 3.
  四川大学华西第二医院急诊科
基金项目:
国家自然科学基金(No：82071353)；四川省科技厅重点研发项目(No：2021YFS0029)

详细信息

通讯作者: 李熙鸿，E-mail：hilixihong@163.com

中图分类号: R459.7

收稿日期: 2024-09-14

刊出日期: 2025-01-10

Association between hemoglobin glycation index and poor prognosis in patients with sepsis

- 1.
  Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, 610041, China
- 2.
  Department of Pediatrics, West China Second University Hospital, Sichuan University
- 3.
  Department of Emergency, West China Second University Hospital, Sichuan University

More Information

Corresponding author: LI Xihong, E-mail: hilixihong@163.com

Received Date: 14 September 2024

Publish Date: 10 January 2025

摘要

摘要: 目的探讨血红蛋白糖化指数(hemoglobin glycation index，HGI)对脓毒症患者全因死亡率的预测价值。方法选取MIMIC-Ⅳ 3.0中符合脓毒症3.0诊断标准首次入住重症监护病房(intensive care unit，ICU)的3 106例成年患者。收集患者的临床资料，基于HGI的四分位数分组(Q1、Q2、Q3和Q4组)，绘制K-M生存曲线，并使用log-rank检验比较组间生存状态的差异。采用多因素Cox比例风险回归模型探讨HGI与全因死亡率之间的相关性。通过限制性立方样条回归和亚组分析对结果进行验证，以评估其稳健性。结果 3 106例患者中，ICU 28 d死亡率、住院死亡率和ICU死亡率分别为22.12%、19.96%和14.94%。Kaplan-Meier曲线和log-rank检验显示，Q1组的中位生存时间显著短于其他组(P < 0.01)。多因素Cox比例风险回归分析表明，HGI与脓毒症患者死亡风险显著相关(P < 0.05)，即HGI降低与死亡风险增加相关。限制性立方样条回归分析显示，HGI增加使ICU 28 d死亡率和住院死亡率线性下降，ICU死亡率虽非线性下降，但也随HGI增加而降低。不同结局的亚组间效应大小和方向保持一致。结论 HGI低水平与脓毒症患者不良预后显著相关。
- 脓毒症 /
- 血红蛋白糖化指数 /
- 预后 /
- 重症监护医学信息数据库
Abstract: Objective To investigate the predictive value of the hemoglobin glycation index(HGI) for mortality in sepsis patients.Methods A total of 3 106 adult patients from the MIMIC-Ⅳ 3.0 database met the diagnostic criteria for sepsis 3.0. Clinical data were collected and patients were stratified based on HGI quartiles(Q1, Q2, Q3 and Q4). Kaplan-Meier survival curves and log-rank tests were used to compare survival differences between groups. The association between HGI and mortality was examined using the multivariate Cox proportional hazards regression model. The results were validated using RCS regression and subgroup analyses to assess their robustness.Results The 28-day mortality, hospital mortality, and ICU mortality were 22.12%, 19.96% and 14.94%, respectively. Kaplan-Meier curves and log-rank tests indicated that the median survival time for the Q1 group was significantly shorter than that for other groups(P < 0.01). Multivariate Cox proportional hazards regression analysis showed that lower HGI was significantly associated with increased mortality risk in sepsis(P < 0.05), indicating that a decrease in HGI was associated with higher mortality risk.RCS analysis revealed that an increase in HGI was associated with a linear decrease in 28-day and hospital mortality, while ICU mortality decreased non-linearly with increasing HGI levels. The effect size and direction of different outcomes remained consistent across subgroups.Conclusion Low HGI is significantly associated with poor prognosis in sepsis.
- sepsis /
- hemoglobin glycation index /
- prognosis /
- MIMIC-IV

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图 1 28 d死亡率Kaplan-Meier生存曲线

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图 2 HGI与脓毒症全因死亡风险的RCS回归分析

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图 3 HGI与脓毒症全因死亡风险的亚组分析森林图

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表 1 不同血红蛋白糖化指数组间的临床特征比较M(P₂₅，P₇₅)

指标	Q1(≤-0.861)	Q2(-0.861，-0.337)	Q3(-0.337，0.367)	Q4(>0.367)	P
男/例(%)	457(58.82)	485(62.42)	459(59.15)	465(59.92)	0.460
年龄/岁	63.57(51.39，73.40)	67.41(55.45，77.63)	70.68(60.23，78.81)	66.06(55.85，74.54)	< 0.001
体重/kg	77.9(67.3，94.0)	80.0(68.8，95.7)	83.3(69.5，100.0)	85.5(72.0，103.0)	< 0.001
生命体征
心率/(次/min)	91(78，106)	86(73，100)	85(73，100)	89(76，102)	< 0.001
收缩压/mmHg	123(105，142)	127(108，143)	128(111，146)	128(111，147)	< 0.001
实验室检查
WBC/(×10⁹/L)	13.8(9.5，19.0)	11.3(8.3，15.5)	10.4(8.0，14.7)	11.4(8.3，16.1)	< 0.001
PLT/(×10⁹/L)	210(152，278)	210(157，281)	212(160，274)	225(169，288)	0.006
Hb/(g/dL)	11.9(9.9，13.8)	12.1(10.5，13.8)	12.3(10.5，13.6)	11.9(10.1，13.4)	0.040
RDW/%	14.0(13.2，15.8)	13.9(13.1，15.1)	14.2(13.3，15.5)	14.1(13.2，15.5)	0.003
ALT/(IU/L)	39.0(21.0，82.7)	30.0(18.0，58.0)	30.0(17.5，51.0)	31.0(20.0，51.0)	< 0.001
AST/(IU/L)	62.4(33.0，128.5)	47.0(26.0，87.0)	41.0(24.5，79.5)	44.8(25.0，82.5)	< 0.001
ALP/(IU/L)	86.0(67.0，115.0)	81.0(64.0，98.0)	84.0(66.0，105.8)	91.0(75.0，119.9)	< 0.001
TB/(mg/dL)	0.7(0.5，1.1)	0.7(0.5，0.9)	0.6(0.5，0.9)	0.6(0.4，0.8)	< 0.001
BUN/(mg/dL)	20(14，34)	19(14，31)	21(15，30)	23(15，40)	< 0.001
SCr/(mg/dL)	1.2(0.9，1.8)	1.0(0.8，1.5)	1.0(0.8，1.4)	1.2(0.8，1.9)	< 0.001
PT/s	13.3(11.9，15.9)	13.0(11.9，15.2)	13.4(12.1，15.7)	13.1(11.9，15.1)	0.016
PTT/s	30.7(26.8，39.9)	30.2(26.4，38.3)	30.2(26.6，37.5)	29.6(26.4，35.4)	0.007
AG/(mEq/L)	17(14，21)	15(13，17)	15(13，17)	16(13，19)	< 0.001
钠/(mEq/L)	138(135，140)	138(136，141)	139(136，141)	137(134，140)	< 0.001
钾/(mEq/L)	4.3(3.9，4.8)	4.2(3.8，4.6)	4.2(3.9，4.6)	4.3(3.9，4.9)	< 0.001
氯/(mEq/L)	102(98，105)	103(99，106)	103(99，105)	101(97，105)	< 0.001
HbA1c/%	5.3(5.0，5.7)	5.6(5.4，5.8)	6.1(5.8，6.4)	8.4(7.2，10.4)	< 0.001
FPG/(mg/dL)	183(134，272)	130(109，160)	126(104，162)	192(140，301)	< 0.001
HGI/%	-1.24(-1.63，-1.01)	-0.58(-0.71，-0.46)	-0.06(-0.22，0.14)	1.47(0.74，2.82)	< 0.001
疾病严重程度评分/分
SOFA	7(5，10)	6(4，9)	5(3，8)	6(4，8)	< 0.001
CCI	6(4，8)	6(4，8)	6(5，8)	7(5，9)	< 0.001
SAPS Ⅱ	39(32，50)	37(29，45)	35(29，43)	38(30，46)	< 0.001
APS Ⅲ	59(44，83)	52(38，72)	48(36，67)	55(42，74)	< 0.001
合并症/例(%)
肾脏疾病	158(20.33)	151(19.43)	166(21.39)	239(30.80)	< 0.001
恶性肿瘤	60(7.72)	50(6.44)	51(6.57)	58(7.47)	0.690
充血性心力衰竭	244(31.40)	252(32.43)	323(41.62)	306(39.43)	< 0.001
糖尿病	204(26.25)	170(21.88)	265(34.15)	692(89.18)	< 0.001
高血压	297(38.22)	363(46.72)	363(46.78)	339(43.69)	0.002
脑卒中	204(26.25)	233(29.99)	234(30.15)	190(24.48)	0.027
肺炎	248(31.92)	254(32.69)	275(35.44)	275(35.44)	0.320
休克	144(18.53)	107(13.77)	95(12.24)	144(18.56)	< 0.001
慢性阻塞性肺疾病	80(10.30)	68(8.75)	89(11.47)	78(10.05)	0.370
冠心病	248(31.92)	230(29.60)	216(27.84)	260(33.51)	0.077
房颤	219(28.19)	273(35.14)	333(42.91)	221(28.48)	< 0.001
肝病	113(14.54)	55(7.08)	48(6.19)	37(4.77)	< 0.001
急性肾衰竭	635(81.72)	619(79.67)	644(82.99)	627(80.80)	0.390
感染部位/例(%)
肺部感染	158(20.33)	160(20.59)	168(21.65)	149(19.20)	0.690
消化系感染	53(6.82)	31(3.99)	35(4.51)	40(5.15)	0.064
泌尿系感染	146(18.79)	140(18.02)	166(21.39)	168(21.65)	0.180
其他感染	328(42.21)	270(34.75)	264(34.02)	336(43.30)	< 0.001
糖皮质激素/例(%)	20(2.57)	19(2.45)	20(2.58)	25(3.22)	0.780
注：1 mmHg=0.133 kPa。

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表 2 不同血红蛋白糖化指数组间不良事件及临床预后对比 M(P₂₅，P₇₅)

指标	Q1(≤-0.861)	Q2(-0.861，-0.337)	Q3(-0.337，0.367)	Q4(>0.367)	P
住院时间/d	14.8(13.3)	15.7(15.3)	15.5(13.5)	17.2(15.9)	0.004
院内死亡/例(%)	200(25.74)	148(19.05)	139(17.91)	133(17.14)	< 0.001
ICU停留时间/d	8.3(8.9)	8.5(8.6)	8.1(8.1)	8.6(9.0)	0.870
ICU死亡/例(%)	157(20.21)	115(14.80)	94(12.11)	98(12.63)	< 0.001
28 d死亡/例(%)	219(28.19)	180(23.17)	150(19.33)	138(17.78)	< 0.001
注：ICU死亡指患者在ICU期间死亡；28 d死亡指患者进入ICU后28 d内发生的死亡事件。

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表 3 脓毒症患者全因死亡率的Cox回归分析

暴露	模型1		模型2		模型3
暴露	HR(95%CI)	P	HR(95%CI)	P	HR(95%CI)	P
ICU 28 d全因死亡率
HGI^a)	0.86(0.82~0.91)	< 0.001	0.87(0.82~0.92)	< 0.001	0.90(0.86~0.95)	< 0.001
Q1^b)	1.77(1.43~2.19)	< 0.001	1.71(1.38~2.13)	< 0.001	1.48(1.18~1.85)	0.001
Q2^b)	1.36(1.09~1.70)	0.007	1.26(1.01~1.57)	0.044	1.36(1.08~1.72)	0.009
Q3^b)	1.10(0.87~1.38)	0.430	0.99(0.78~1.25)	0.918	1.17(0.92~1.48)	0.199
住院全因死亡率
HGI^a)	0.87(0.82~0.92)	< 0.001	0.88(0.83~0.93)	< 0.001	0.91(0.86~0.96)	0.001
Q1^b)	1.72(1.38~2.15)	< 0.001	1.68(1.34~2.10)	< 0.001	1.41(1.11~1.78)	0.004
Q2^b)	1.24(0.98~1.56)	0.078	1.17(0.93~1.49)	0.186	1.17(0.92~1.50)	0.204
Q3^b)	1.16(0.92~1.48)	0.215	1.09(0.85~1.38)	0.505	1.16(0.91~1.48)	0.236
ICU全因死亡率
HGI^a)	0.86(0.80~0.92)	< 0.001	0.86(0.81~0.93)	< 0.001	0.89(0.83~0.95)	0.001
Q1^b)	1.65(1.28~2.12)	< 0.001	1.59(1.23~2.06)	< 0.001	1.42(1.09~1.85)	0.010
Q2^b)	1.21(0.92~1.59)	0.163	1.17(0.89~1.54)	0.255	1.23(0.92~1.64)	0.157
Q3^b)	1.07(0.80~1.42)	0.660	1.01(0.76~1.35)	0.936	1.14(0.85~1.52)	0.397
注：^a)HGI作为连续性变量纳入Cox比例风险回归模型；^b)HGI作为分类变量纳入Cox比例风险回归模型，以Q4为参考组。模型1：未调整协变量；模型2：调整年龄、性别、体重；模型3：调整年龄、性别、体重、心率、收缩压、SOFA评分、CCI评分及既往糖皮质激素使用情况。

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