Association Between Hemoglobin Glycation Index and All-Cause Mortality Among Critically Ill Patients with Hemorrhagic Stroke: A Multicenter Retrospective Study.

Abstract

Hemorrhagic stroke (HS) is a leading cause of mortality and disability worldwide. The hemoglobin glycation index (HGI) has been shown to closely correlate with adverse outcomes in various diseases. However, the relationship between HGI and mortality in patients with HS has not yet been clarified. This study investigated the association between HGI and all-cause mortality (ACM) in critically ill patients with HS using the Medical Information Mart for Intensive Care IV database. HGI values were calculated by constructing a linear regression equation between glycated hemoglobin and fasting plasma glucose. Cox proportional hazards models, restricted cubic splines, and subgroup analyses were employed to comprehensively evaluate the prognostic significance of HGI in HS patients. Finally, the clinical applicability of HGI was further validated using external clinical data. This study encompassed 1664 patients, among whom 254 (15.26%) died within 30 days. Cox regression analysis demonstrated a significant inverse relationship between HGI and 30-day ACM in the HS population. After adjusting for all covariates, patients in the higher HGI groups (T2 and T3) exhibited a significantly lower risk of death compared with the low-HGI group (T1) (T2: hazard ratio [95% confidence interval], 0.482 [0.350, 0.662], P  <  0.001; T3: hazard ratio [95% confidence interval], 0.656 [0.477, 0.902], P  =  0.009). Restricted cubic spline analysis demonstrated a nonlinear relationship between HGI and ACM (P for nonlinearity <0.001). Subgroup analysis revealed a significant interaction between age and HGI concerning 30-day ACM. This study proves that higher HGI is significantly associated with reduced ACM in patients with HS. HGI may serve as a valuable monitoring index and a tool for risk stratification.