{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T04:10:56Z","timestamp":1788667856662,"version":"build-2803163510"},"reference-count":40,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Glycemic variability is common in critical illness and can obscure the prognostic significance of premorbid glycemic status. Hemoglobin A1c (HbA1c) reflects chronic glycemia and may improve risk stratification beyond acute glucose measurements. We examined whether HbA1c-defined glycemic phenotypes were associated with in-hospital complications and mortality among critically ill adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective cohort study using MIMIC-IV (v3.1), a de-identified database of ICU admissions at Beth Israel Deaconess Medical Center (2008-2019). Adults (\u226518 years) with a documented HbA1c during the index hospitalization and first ICU admission were included (\n                      <jats:italic toggle=\"yes\">N<\/jats:italic>\n                      \u2009=\u200913,552). Patients were classified into eight mutually exclusive groups based on diabetes diagnosis status and HbA1c: healthy (\u22645.7% without diabetes), undiagnosed prediabetes (5.8%\u20136.4%), undiagnosed diabetes (\u22656.5%), and five diagnosed-diabetes strata (&lt;6.0%, 6.0%\u20136.9%, 7.0%\u20137.9%, 8.0%\u20138.9%, \u22659.0%). Multivariable logistic regression adjusted for age and sex compared each group with healthy controls for composite complications and in-hospital mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      HbA1c was available in 20.7% of first ICU admissions; 40.7% of included patients had diagnosed diabetes and 2.6% had undiagnosed diabetes. Compared with healthy controls, odds of any complication were higher in undiagnosed prediabetes (OR 1.28, 95% CI 1.11-1.48;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u2009.001) and several diagnosed-diabetes strata (OR range 1.31-1.90; all\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009\u2264\u2009.006). Renal complications showed the most consistent elevation across dysglycemic groups, including very poor glycemic control (OR 2.22, 95% CI 1.95-2.53;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u2009.001). Sepsis-related complications were increased across all diabetes-range groups; undiagnosed diabetes had OR 2.08 (95% CI 1.53-2.83;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u2009.001). In-hospital mortality was highest in undiagnosed diabetes (OR 2.33, 95% CI 1.73-3.14;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u2009.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among ICU patients in whom HbA1c was measured, HbA1c-defined dysglycemia, particularly undiagnosed diabetes, was associated with substantially higher ICU morbidity and mortality. Because HbA1c testing was selective and provided limited incremental prognostic value beyond established severity scores, these findings should be considered hypothesis-generating and require prospective validation before supporting routine HbA1c screening.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08850666261483519","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:20:13Z","timestamp":1788495613000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["HbA1c Stratification Identifies High-Risk ICU Patients: Mortality and Complications in a Retrospective Critical Care Cohort"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2125-1725","authenticated-orcid":false,"given":"Paul","family":"Karim","sequence":"first","affiliation":[{"name":"Boston University Chobanian & Avedisian School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2028-9991","authenticated-orcid":false,"given":"Isaac","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9890-7978","authenticated-orcid":false,"given":"Jiahui","family":"Chen","sequence":"additional","affiliation":[{"name":"University of Texas at Austin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7555-4872","authenticated-orcid":false,"given":"Marco","family":"Sanvitti","sequence":"additional","affiliation":[{"name":"University of Tor Vergata"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5645-578X","authenticated-orcid":false,"given":"Robert","family":"Canelli","sequence":"additional","affiliation":[{"name":"Boston University Chobanian & Avedisian School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Bilotta","sequence":"additional","affiliation":[{"name":"University of Tor Vergata"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011300"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0810625"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1080\/21548331.2015.1066227"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-014-3287-7"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.4103\/0972-5229.175938"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-S002"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/1060028014547383"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2014.08.014"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41597-022-01899-x"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-009952"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2022.01.014"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2025.4706"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-198701000-00003"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268807008564"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a009804"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocx084"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics9090536"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S273853"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2012.01440.x"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10877-021-00664-6"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtha.2024.10.013"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(19)30354-6"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-023-02082-z"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2013.089"},{"key":"e_1_3_2_26_2","first-page":"243","volume-title":"Strategies to Improve Cardiac Arrest Survival: A Time to Act","author":"Graham R","year":"2015","unstructured":"Graham R, McCoy MA, Schultz AM. 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