Glycosylated Hemoglobin as a Predictor of Sepsis and All-Cause Mortality in Trauma Patients

Figures & data

Figure 1 Flowchart of patient enrollment.

Table 1 Demographic and Clinical Characteristics of Patients Included

Characteristics n (%) [Mean(SD) or Median, IQR]	Overall (n=397)	Low HbA1c HbA1c < 6.5% (n=259)	High HbA1c HbA1c > 6.5% (n=138)	p
Demographic
Age, years>65	114 (28.7)	60 (23.2)	54 (39.1)	<0.001
Gender, Male	280 (70.5)	194 (74.9)	86 (62.3)	0.012
BMI	26.90 (24.20,30.25)	26.14 (23.48,29.35)	27.82 (24.73,32.18)	<0.001
Initial GCS	8 (3,15)	8 (3,15)	7.50 (3,13)	0.256
Initial SOFA	4 (3,6)	4 (2,5)	4 (3,7)	0.011
Comorbidities
Diabetes	63 (15.9)	34 (13.1)	29 (21.0)	0.057
CHF	46 (11.6)	17 (6.6)	29 (21.0)	<0.001
Hypertension	105 (26.4)	66 (25.5)	39 (28.3)	0.633
COPD	55 (13.9)	30 (11.6)	25 (18.1)	0.101
Coagulation disorder	37 (9.3)	17 (6.6)	20 (14.5)	0.016
Alcohol abuse	65 (16.4)	48 (18.5)	17 (12.3)	0.147
Vital signs
Body Temperature C	36.4 (35.8,37.1)	36.5 (35.8,37.1)	36.4 (35.8,37.1)	0.487
Heart Rate (beats/minute)	86 (75,102)	86 (74,99)	86 (75,104)	0.546
Systolic BP (mmHg)	127.09 (25.32)	128.19 (25.24)	125.01 (25.43)	0.233
Diastolic BP (mmHg)	65 (57,77)	66 (59,78)	64 (53,73)	0.025
MAP (mmHg)	84 (72,96)	85 (73,97)	81.67 (70,93)	0.084
Respiratory Rate	17 (14,20)	17 (14,20)	17 (14.25,20)	0.796
SpO2 (%)	100 (97,100)	100 (97,100)	100 (98,100)	0.305
Arterial blood gas parameters
Base excess	−2 (−5,0)	−2 (−5,0)	−1 (−5,2)	0.007
Lactate	2.40 (1.70,3.40)	2.40 (1.90,3.45)	2.20 (1.33,3.40)	0.004
PCO2 (mmHg)	43 (39,48)	43 (39,48.50)	43 (37.25,47)	0.237
PH	7.34 (7.28,7.40)	7.34 (7.27,7.38)	7.35 (7.30,7.42)	0.006
PO2 (mmHg)	190 (107,308)	190 (112,284.50)	190 (102.50,319.25)	0.956
Bicarbonate (mmol/L)	23 (21,26)	23 (21,25)	24 (22,27)	0.013
Anion Gap	14 (12,16)	14 (12,16)	15 (13,17)	0.036
Laboratory test
Albumin (mg/dL)	3 (2.80,3.10)	3 (3,3.10)	3 (2.50,3)	0.002
Amylase	59.50 (52,65)	59.50 (57,70)	59.50 (46.50,59.88)	0.082
Creatinine	1 (0.80,1.20)	1 (0.80,1.10)	1 (0.80,1.30)	0.262
Blood glucose	136 (112,168)	135 (112.50,162)	139 (109,176.25)	0.426
Lipase	31 (26,36)	31 (27.50,38)	31 (24,32.75)	0.192
Urea nitrogen	16 (12,22)	15 (12,20)	17 (13,26)	0.015
Hemoglobin (g/dL)	12.24 (2.15)	12.47 (2.15)	11.80 (2.08)	0.003
INR	1.20 (1.10,1.40)	1.20 (1.10,1.30)	1.20 (1.10,1.50)	0.001
Neutrophils (%)	81.35 (79,83.40)	81.35 (79.30,82.95)	81.35 (78,83.75)	0.796
Platelet (10 9 /L)	253 (186,319)	250 (190,310)	262.50 (176.50,342.75)	0.524
PT (seconds)	13.40 (12.70,15)	13.30 (12.60,14.50)	13.70 (12.80,16.32)	0.007
APTT (seconds)	26.80 (24,32)	26.30 (23.70,29.80)	27.70 (24.75,34.53)	0.009
WBC (10 9 /L)	12.80 (9.40,17.30)	12.70 (9.50,17.25)	12.90 (9.10,17.45)	0.855
Outcomes
Sepsis	198 (49.9)	93 (35.9)	105 (76.1)	<0.001
Length of EICU stay (day)	4 (2,10)	3 (2,8)	6 (3,12)	0.001
Length of hospital stay (day)	12 (6,21)	10 (5,18.50)	14 (8,25)	<0.001
30-day mortality	60 (15.1)	19 (7.3)	41 (29.7)	<0.001

Abbreviations: GCS, Glasgow score; SOFA, sequential organ failure assessment; CHF, congestiveheartfailure; COPD, chronic obstructive pulmonary disease; MAP, meanarterialpressure; INR, international normalized ratio; PT, prothrombintime; APTT, activated partial thromboplastin time; WBC; white blood cell.

Table 2 Univariate Analysis of Independent Predictors for Sepsis Morbidity of EICU Trauma Patients

	OR (95% CI for OR)	p-value
Age, years>65	1.74 (1.12~2.72)	0.014
Gender, Male	0.63 (0.56~1.28)	0.257
BMI	1.11 (1.07~1.16)	<0.001
DM	3.93 (2.16~7.51)	<0.001
CHF	5.67 (2.7~13.41)	<0.001
Hypertension	2.29 (1.45~3.66)	<0.001
COPD	2.81 (1.54~5.34)	0.001
Coagulation disorder	3.48 (1.66~8)	0.002
Alcohol abuse	0.78 (0.45~1.32)	0.355
Body Temperature°C	0.96 (0.8~1.15)	0.647
Heart Rate (beats/minute)	1 (0.99~1.01)	0.521
Systolic BP (mmHg)	0.99 (0.98~1)	0.006
Diastolic BP (mmHg)	0.99 (0.98~1)	0.086
MAP (mmHg)	0.99 (0.98~1)	0.074
Respiratory Rate (beats/minute)	1.01 (0.98~1.05)	0.446
SpO2 (%)	0.95 (0.9~1)	0.065
Initial GCS	0.94 (0.9~0.98)	0.003
Initial SOFA	1.25 (1.14~1.37)	<0.001
Base excess (mmol/L)	1.03 (1~1.08)	0.075
Lactate (mmol/L)	0.95 (0.87~1.03)	0.206
PCO2 (mmHg)	1.01 (0.99~1.03)	0.251
PH	1.95 (0.36~10.82)	0.438
PO2 (mmHg)	1 (1~1)	0.694
Bicarbonate (mmol/L)	1.06 (1~1.11)	0.039
Anion Gap (mmol/L)	1.02 (0.96~1.08)	0.506
Albumin (g/dL)	0.65 (0.44~0.94)	0.025
Amylase (IU/l)	1 (1~1)	0.808
Creatinine (mg/dL)	2.37 (1.49~4.09)	0.001
Blood glucose (mg/dL)	1 (1~1.01)	0.045
Lipase (IU/L)	1 (1~1)	0.524
Urea nitrogen (mg/dL)	1.03 (1.01~1.05)	0.001
Hemoglobin (g/dL)	0.83 (0.75~0.91)	<0.001
INR	1.54 (1.16~2.16)	0.007
Neutrophils (%)	0.98 (0.96~1.01)	0.156
Platelet (10^9 /L)	1 (1~1)	0.003
PT (seconds)	1.01 (0.99~1.03)	0.455
APTT (seconds)	1.01 (1~1.02)	0.056
WBC (10^9 /L)	1 (0.97~1.03)	0.871
HbA1c >6.5%	5.68 (3.6~9.16)	<0.001

Abbreviations: GCS, Glasgow score; SOFA, sequential organ failure assessment; CHF, congestiveheartfailure; COPD, chronic obstructive pulmonary disease; MAP, meanarterialpressure; INR, international normalized ratio; PT, prothrombintime; APTT, activated partial thromboplastin time; WBC, white blood cell; BMI, body mass index.

Table 3 Multivariate Analysis of Independent Predictors for Sepsis of EICU Trauma Patients

	OR (95% CI for OR)	p-value
Complicated with
Diabetes	3.1 (1.41–6.79)	0.005
Hypertension	2.55 (1.35–4.82)	0.004
Coagulation disorder	3.45 (1.23–9.67)	0.018
HbA1c >6.5%	2.05 (1.65–2.54)	<0.001
Creatinine (per 1mg/dL)	3.71 (1.66–8.31)	<0.001
Urea nitrogen (per 1mg/dL)	0.96 (0.92–0.99)	0.021
Platelet (per 1×10^9 /L)	1 (1–1)	0.083
Initial GCS (Upper by 1)	0.93 (0.88–0.99)	0.015
BMI	1.08 (1.03–1.13)	0.001

Abbreviations: GCS, Glasgow score; BMI, body mass index.

Figure 2 Kaplan–Meier survival curves categorized by HbA1c.

Table 4 Univariate Analysis of Independent Predictors for EICU Trauma Patients’ Mortality

	HR(95% CI for HR)	p-value
Age, years>65	5.2 (3.4–7.8)	<0.001
Gender, Male	0.51 (0.34–0.76)	0.001
BMI	0.99 (0.96–1)	0.400
DM	1 (0.61–1.7)	0.920
CHF	4.5 (2.9–7.1)	<0.001
Hypertension	0.97 (0.61–1.5)	0.890
COPD	1.7 (1.1–2.8)	0.024
Coagulation disorder	3.5 (2.2–5.7)	<0.001
Alcohol abuse	0.67 (0.37–1.2)	0.190
Body Temperature°C	0.85 (0.71–1)	0.084
Heart Rate (beats/minute)	1 (0.99–1)	0.490
Systolic BP (mmHg)	1 (0.99–1)	0.500
Diastolic BP (mmHg)	0.98 (0.97–0.99)	0.007
MAP (mmHg)	0.99 (0.98–1)	0.140
Respiratory Rate (beats/minute)	0.98 (0.94–1)	0.320
SpO2 (%)	0.98 (0.94–1)	0.160
Initial GCS	0.99 (0.95–1)	0.640
Initial SOFA	1.2 (1.1–1.3)	<0.001
Base excess (mmol/L)	1.1 (1–1.1)	0.010
Lactate (mmol/L)	1 (0.94–1.1)	0.550
PCO2 (mmHg)	0.97 (0.94–1)	0.023
PH	22 (2.8–180)	0.003
PO2 (mmHg)	1 (1–1)	0.270
Bicarbonate (mmol/L)	1.1 (1–1.1)	0.002
Anion Gap (mmol/L)	1 (0.97–1.1)	0.270
Albumin (g/dL)	0.45 (0.31–0.64)	<0.001
Amylase (IU/l)	1 (0.99–1)	0.520
Creatinine (mg/dL)	1.3 (1.2–1.5)	<0.001
Blood glucose (mg/dL)	1 (1–1)	0.900
Lipase (IU/L)	1 (1–1)	0.770
Urea nitrogen (mg/dL)	1 (1–1)	<0.001
Hemoglobin (g/dL)	0.8 (0.73–0.87)	<0.001
INR	1.3 (1.2–1.4)	<0.001
Neutrophils (%)	1 (0.99–1)	0.300
Platelet (109 /L)	1 (1–1)	0.350
PT (seconds)	1 (1–1)	0.160
APTT (seconds)	1 (1–1)	<0.001
WBC (109 /L)	1 (0.97–1)	0.980
HbA1c >6.5%	4.7 (3.1–7.2)	<0.001

Abbreviations: GCS, Glasgow score; SOFA, sequential organ failure assessment; CHF, congestiveheartfailure; COPD, chronic obstructive pulmonary disease; MAP, meanarterialpressure; INR, international normalized ratio; PT, prothrombintime; APTT, activated partial thromboplastin time; WBC, white blood cell; BMI, body mass index.

Table 5 Multivariate Analysis of Independent Predictors for EICU Trauma Patients’ Mortality

	HR(95% CI for HR)	p-value
Gender, Male	1.94 (1.21–3.12)	0.006
HbA1c >6.5%	1.45 (1.32–1.6)	<0.001
Albumin (per 1g/dL)	0.54 (0.34–0.86)	0.010
Creatinine (per 1mg/dL)	1.02 (1.01–1.03)	0.004
APTT (per 1seconds)	1.02 (1.01–1.03)	<0.001
Initial SOFA (Upper by 1)	1.2 (1.1–1.31)	<0.001
Age, years>65	3.21 (1.95–5.3)	<0.001

Abbreviations: SOFA, sequential organ failure assessment; APTT, activated partial thromboplastin time.

Figure 3 Chronic hyperglycemia caused VEG shedding and adverse consequences.