Glycated Hemoglobin: a promising biomarker for predicting acute exacerbation and short-term mortality of chronic obstructive pulmonary disease

Abstract Background and objectives Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory condition, often complicated by frequent exacerbations and increased mortality risk. COPD patients also had a higher risk for developing diabetes mellites. Recently, the studies showed promising utility of HbA1C in identifying patients at heightened risk of critical illnesses. This study evaluated the diagnostic and prognostic value of glycated hemoglobin (HbA1c) in predicting COPD exacerbation and short-term mortality. Methods A prospective cohort study involved 184 COPD patients. Patients were categorized as either stable or experiencing an acute exacerbation. Demographic and laboratory data, including HbA1c levels, were collected. Results HbA1c levels were significantly elevated in COPD patients experiencing exacerbations. Factors influencing HbA1c levels included lower oxygen saturation upon admission, use of home oxygen, lymphocyte count, CRP levels, diabetes, and ischemic heart disease (IHD). HbA1c emerged as a strong predictor of both COPD exacerbation and short-term mortality. In the unadjusted model, HbA1c was associated with an increased risk of exacerbation (OR = 1.59, p = 0.001) and remained significant after adjusting for other variables (OR = 2.25, p = 0.03). Similarly, HbA1c was a significant predictor of mortality in both the unadjusted (OR = 1.44, p = 0.001) and adjusted models (OR = 1.66, p = 0.001). Notably, the use of home oxygen was associated with a lower risk of both exacerbation and mortality. Other risk factors for exacerbation included lower oxygen saturation, male sex, IHD, and a history of previous exacerbations. The mortality rate was significantly higher in patients who had experienced recent exacerbations. Conclusion Elevated HbA1c levels were consistently associated with a higher risk of adverse outcomes, even after adjusting for other significant factors. This highlights the importance of routine HbA1c monitoring in COPD management, particularly in patients with a history of exacerbations or comorbid conditions like diabetes and ischemic heart disease. Additionally, the protective effect of home oxygen therapy against exacerbations and mortality suggests it should be considered as a key component in the management strategy for high-risk COPD patients.