HbA1c Stratification Identifies High-Risk ICU Patients: Mortality and Complications in a Retrospective Critical Care Cohort

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Introduction 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. Methods 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 (≥18 years) with a documented HbA1c during the index hospitalization and first ICU admission were included ( N = 13,552). Patients were classified into eight mutually exclusive groups based on diabetes diagnosis status and HbA1c: healthy (≤5.7% without diabetes), undiagnosed prediabetes (5.8%–6.4%), undiagnosed diabetes (≥6.5%), and five diagnosed-diabetes strata (