ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Cardiovascular Endocrinology
The hemoglobin glycation index stratifies heart failure phenotypes and in-hospital risk
Provisionally accepted
Chuxin Lyu1,2
Xinyu Tong3
Pingyang Fu1,2Yuan Gao1,2Jiayi Hua1,2
Jiajing Zhao1,2
Peng Yu1Xiaohu Chen1*Dongling Lyu1*- 1Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
- 2Nanjing University of Chinese Medicine, Nanjing, China
- 3Wuxi Hospital of Traditional Chinese Medicine, Wuxi, China
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Objective: To evaluate the association between the hemoglobin glycation index (HGI) and ejection fraction (EF) categories in hospitalized heart failure (HF) patients and to investigate the relationship between HGI and in-hospital worsening heart failure (WHF). Methods: This single-center retrospective study included 647 HF patients (261 HFrEF, 186 HFmrEF, 200 HFpEF). HGI was calculated as measured HbA1c minus predicted HbA1c (derived from fasting plasma glucose regression). Ordinal multinomial logistic regression and binomial logistic regression were used to evaluate the relationships between HGI (exposure) and EF-based phenotypes and in-hospital WHF (outcome), respectively, with stepwise adjustment for confounding factors. Dose-response relationships were assessed using restricted cubic spline (RCS) analysis. Results: HFrEF patients exhibited the highest HGIs and the highest incidence of In-hospital WHF (33.72% vs. 18.82% [HFmrEF] and 14.00% [HFpEF]; P < 0.001). After full adjustment, a higher HGI was significantly associated with the HFrEF phenotype. For every 1-unit increase in HGI, the probability of being classified into a higher EF category (HFrEF → HFmrEF/HFpEF) decreased by approximately 25% (OR = 0.746, 95% CI 0.617–0.902; P = 0.003; P for trend = 0.029). Regarding outcomes, HGI showed a stable, positive association with In-hospital WHF. After full adjustment, every 1-unit increase in HGI increased the risk of In-hospital WHF 2.16-fold (OR=2.161, 95% CI 1.680–2.840; P<0.001). When divided into quartiles (Q1 as reference), the ORs for In-hospital WHF in Q2, Q3, and Q4 were 2.790, 3.811, and 7.322, respectively (P for trend < 0.001). RCS analysis revealed an approximately linear dose‒response relationship. Conclusion: In hospitalized HF patients, a higher HGI was significantly associated with the HFrEF phenotype and an increased risk of in-hospital WHF. HGI may serve as a potential supplementary indicator for phenotype characterization and risk stratification.
Keywords: Hemoglobin glycation index, Heart Failure, ejection fraction, Worsening heart failure, in-hospital outcomes
Received: 06 Nov 2025; Accepted: 28 Nov 2025.
Copyright: © 2025 Lyu, Tong, Fu, Gao, Hua, Zhao, Yu, Chen and Lyu. 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:
Xiaohu Chen
Dongling Lyu
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