ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Cardiovascular Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1656783
This article is part of the Research TopicData Science in Anesthesiology and Intensive CareView all articles
Distinct Patterns of Association between the Hemoglobin Glycation Index, the Stress–Hyperglycemia Ratio, and the Risk of New-onset Atrial Fibrillation in Critically Ill Patients
Provisionally accepted
- 1Nanjing Medical University, Nanjing, China
- 2Nanjing First Hospital, Nanjing, China
- 3The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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This study investigated the associations between two novel glycemic indices, the hemoglobin glycation index (HGI) and the stress hyperglycemia ratio (SHR), and the risk of new-onset atrial fibrillation (NOAF) in critically ill patients. We retrospectively analyzed data from 3,882 adults in the MIMIC-IV database, with the primary outcome defined as NOAF within 7 days of intensive care unit (ICU) admission. Multivariate Cox regression and restricted cubic spline analyses were used to evaluate associations. NOAF occurred in 750 patients (19.3%). After adjustment for confounders, HGI exhibited a significant inverted U-shaped association with NOAF risk, with the highest risk in intermediate quartiles. In contrast, the SHR demonstrated a significant linear inverse relationship with NOAF risk, with higher SHR quartiles consistently associated with lower risk. These associations were especially pronounced in nondiabetic patients and remained consistent across key clinical subgroups. Our findings indicate that the HGI and SHR independently predict NOAF in critically ill patients and may provide valuable tools for risk stratification and personalized glycemic management in the ICU.
Keywords: Hemoglobin glycation index (HGI), Stress–hyperglycemia ratio (SHR), New-onsetatrial fibrillation (NOAF), critically ill patients, Glycemic variability
Received: 30 Jun 2025; Accepted: 03 Sep 2025.
Copyright: © 2025 Jie, Li, Qian, He, Jia, Zhang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jianping Wang, Nanjing First Hospital, Nanjing, China
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