HbA1c measurement is associated with optimizing outcomes in acute pancreatitis: a retrospective study

HbA1c measurement is associated with optimizing outcomes in acute pancreatitis: a retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article HbA1c measurement is associated with optimizing outcomes in acute pancreatitis: a retrospective study Kang Nie, Xiaoxi Xie, Shizhen Tu, Jinhang Gao, Yufang Wang, Rui Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9409703/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: Glycated hemoglobin (HbA1c), a biomarker reflecting long-term glucose metabolism, has been demonstrated to have predictive value for the prognosis of acute pancreatitis (AP) in previous studies. However, the prognostic benefit of measuring HbA1c has not yet been established. Methods: We extracted data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database for patients with and without HbA1c testing. Propensity score matching (PSM) was used to improve comparability between the tested and control groups. Cox proportional hazards regression and Kaplan–Meier survival analyses were performed to assess the association between HbA1c measurement and all-cause mortality. Causal mediation analysis (CMA) was conducted to evaluate the effect of insulin use on clinical outcomes. Results: A total of 1,210 patients were included in this study, among whom 201 (17%) underwent HbA1c measurement. After PSM, 348 patients were included in the final analysis, with half of them receiving HbA1c measurement.The measurement group demonstrated significantly lower 28-day (8.6% vs 17.2%, p = 0.025) and 90-day(14.4% vs 25.9%, p = 0.011) mortality rates compared to controls. Multivariate Cox regression verified that HbA1c measurement independently correlates with all-cause mortality (HR = 0.45, 95% CI: 0.30–0.69, p < 0.001). Notably, insulin usage was significantly more common in the measurement group (60.9% vs 39.1%, p < 0.001). However, causal mediation analysis revealed that increased insulin administration was associated with elevated mortality risk (p = 0.024). Conclusions: HbA1c testing was associated with reduced all-cause mortality in patients with AP. Routine HbA1c measurement may have a positive impact on clinical outcomes in these patients. Trial registration: Clinical trial number: not applicable. Acute pancreatitis ICU HbA1c Insulin Figures Figure 1 Figure 2 Background Acute pancreatitis (AP) is one of the most common and severe gastrointestinal conditions leading to hospital admission in the United States, with an estimated incidence of 110 to 140 cases per 100,000 population and accounting for over 300,000 emergency department visits annually[ 1 – 4 ]. Approximately 80% of patients present with a mild, self-limiting course and are typically discharged within several days[ 5 ]. However, about 20% develop severe acute pancreatitis (SAP), which is associated with a mortality rate of approximately 20%[ 5 – 7 ]. Current risk stratification tools and clinical indicators for AP remain unsatisfactory[ 8 , 9 ], likely due to the complexity of clinical presentations and patient heterogeneity. Abnormal glucose metabolism is frequently observed in patients with AP, potentially due to stress-related hyperglycemia and pancreatic dysfunction. Elevated blood glucose levels have been correlated with increased disease severity in AP[ 10 – 12 ]. Moreover, administration of glucose-containing fluids has been linked to higher risks of adverse outcomes in patients with AP [ 13 ], underscoring the importance of glucose monitoring and management in this population. Glycated hemoglobin (HbA1c) is a biomarker reflecting average glucose levels over the preceding two to three months[ 14 , 15 ]. Compared to other glycemic markers, HbA1c demonstrates lower intra-individual variability, greater pre-analytical stability, and is less affected by acute stress, dietary changes, or intercurrent illness[ 16 ]. Previous studies have suggested that HbA1c may predict poorer clinical outcomes and aid in diagnosing diabetes mellitus among patients with AP [ 17 – 20 ]. Beyond its diagnostic and prognostic value, HbA1c measurement could influence therapeutic decisions, particularly in guiding glycemic control strategies. However, there is currently insufficient evidence to support the routine inclusion of HbA1c as a standard laboratory parameter for patients with AP. This study aimed to investigate the impact of HbA1c measurement and related therapeutic interventions on all-cause mortality in patients with AP, and to assess the necessity of routine HbA1c testing in AP management. Methods Data Source We conducted a retrospective cohort study using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, a large, publicly available critical care database in the United States. MIMIC-IV contains detailed records for patients admitted to intensive care units (ICUs) or the emergency department between 2008 and 2022[ 21 ]. All data are de-identified to protect patient privacy, and thus the use of this dataset was exempt from institutional review board (IRB) approval and the requirement for informed consent. Access to MIMIC-IV requires completion of the National Institutes of Health (NIH) online course on data use. The first author, Kang Nie, successfully completed the necessary training and was granted access (Certification Record ID: 65828193). Study Population The study included patients diagnosed with AP using International Classification of Diseases, 9th and 10th Revision (ICD-9 and ICD-10) codes. Exclusion criteria were: (1) patients not admitted to the ICU (n = 5,810); (2) non-first-time ICU admissions (n = 420); (3) age younger than 18 years (n = 0); (4) insufficient clinical data (n = 70). After applying these criteria, 1,210 patients were included in the final analysis (Fig. 1 ). Variable Extraction Data were extracted using PostgreSQL (version 17.1) and Navicat Premium (version 17) via structured query language (SQL). The primary exposure variable was HbA1c measurement during hospitalization. Demographic characteristics included age, sex, weight, race, smoking history, alcohol abuse, and all-cause mortality. Laboratory data included admission blood glucose, blood urea nitrogen (BUN), calcium, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, hemoglobin, red blood cell (RBC) count, white blood cell (WBC) count, and platelet count. Severity scores obtained within the first 24 hours of ICU admission included the Sequential Organ Failure Assessment (SOFA) score and the Simplified Acute Physiology Score II (SAPS II). Therapeutic interventions recorded were vasopressor use, mechanical ventilation, and insulin administration. Comorbidities and complications were identified using ICD-9 and ICD-10 codes, including hypertension, heart failure, shock, chronic pulmonary disease, respiratory failure, renal disease, renal failure, cirrhosis, diabetes, and the Charlson comorbidity index. For variables with multiple records, the earliest value was selected for analysis. Statistical Analysis Continuous variables are presented as means with standard deviations (SD) for normally distributed data, and medians with interquartile ranges (IQR) for non-normally distributed data. Categorical variables are summarized as counts and percentages. Group comparisons were performed using one-way analysis of variance (ANOVA) for normally distributed continuous variables, the Kruskal–Wallis test for non-normally distributed continuous variables, and the chi-square (χ²) test for categorical variables. To minimize potential confounding and balance baseline differences between groups, propensity score matching (PSM) was employed. Propensity scores were estimated using a multivariate logistic regression model incorporating variables associated with the likelihood of undergoing HbA1c measurement. One-to-one nearest neighbor matching was conducted with a caliper width of 0.05. Standardized mean differences (SMDs) were calculated to assess covariate balance after matching, with an SMD < 0.1 indicating good balance. Survival analysis was performed using Kaplan–Meier curves and Cox proportional hazards models to compare mortality outcomes between groups after PSM. Cox models were adjusted for demographic characteristics, laboratory data, severity scores, comorbidities, complications, and therapeutic interventions. Causal mediation analysis (CMA) was conducted to explore whether the effect of HbA1c measurement on mortality was mediated by intermediate variables. A logistic regression model assessed mediation effects, while a Cox proportional hazards model served as the outcome model. Direct Counterfactual Imputation was applied, with 1,000 bootstrap samples used to estimate confidence intervals. Sensitivity analyses were performed by excluding patients who experienced early mortality (acute death) and by applying different censoring times prior to Cox regression analysis. All statistical analyses were performed using R software (version 4.4.2). A two-tailed P -value < 0.05 was considered statistically significant. Results Baseline characteristics Of 5,810 hospitalization records reviewed, 1,210 patients met the inclusion criteria and were included in the final analysis ( Figure 1 ). HbA1c was measured in 201 patients (16.6%), with a median value of 6.10% (IQR, 5.60%–8.30%). Baseline characteristics of the HbA1c measurement and non-measurement groups are summarized in Table 1 . Table 1. Baseline characteristics of original cohort Original cohort Non-measurement group Measurement group P value SMD N = 1009 N = 201 Basic information Age (years) 60.23 [47.56, 73.83] 54.37 [42.83, 66.91] <0.001 0.306 Sex (%) Female 447 (44.3) 72 (35.8) 0.032 0.174 Male 562 (55.7) 129 (64.2) Weight (kg) 81.20 [70.00, 98.20] 84.00 [68.70, 102.30] 0.395 0.037 Race (%) <0.001 0.437 White 673 (66.7) 93 (46.3) Unknown 108 (10.7) 33 (16.4) Other 104 (10.3) 29 (14.4) Black 92 (9.1) 38 (18.9) Asian 32 (3.2) 8 (4.0) smoking history (%) 0.088 0.188 Current use 140 (13.9) 42 (20.9) Former use 160 (15.9) 29 (14.4) Never used 222 (22.0) 39 (19.4) Unknown 487 (48.3) 91 (45.3) alcohol_abuse (%) 113 (11.2) 21 (10.4) 0.852 0.024 Laboratory tests HbA1c (%) 0.00 [0.00, 0.00] 6.10 [5.60, 8.30] <0.001 3.922 BUN (mg/dl) 20.00 [12.00, 34.00] 21.00 [12.00, 33.00] 0.883 0.020 Calcium (mg/dl) 8.10 [7.50, 8.70] 8.30 [7.70, 8.90] 0.003 0.222 Creatinine (mg/dL) 1.00 [0.70, 1.80] 1.20 [0.80, 1.80] 0.396 0.102 Glucose (mg/dL) 116.82 (42.30) 135.81 (52.73) <0.001 0.397 ALT (U/L) 47.00 [25.00, 142.00] 42.00 [19.00, 88.00] 0.007 0.100 AST (U/L) 69.00 [34.00, 179.00] 54.00 [27.00, 124.00] 0.003 0.033 Bilirubin total (mg/dL) 1.10 [0.60, 2.80] 0.90 [0.40, 1.80] 0.001 0.041 RBC (×10³/µL) 3.72 [3.20, 4.30] 3.85 [3.32, 4.54] 0.005 0.250 WBC (×10³/µL) 11.90 [7.90, 17.50] 11.60 [8.40, 15.30] 0.275 0.153 Platelet (×10³/µL) 189.00 [131.00, 269.00] 198.00 [143.00, 268.00] 0.308 0.002 Hemoglobin (g/dL) 11.30 [9.60, 13.10] 11.80 [10.10, 13.80] 0.016 0.193 Comorbidities and complications Hypertension (%) 469 (46.5) 95 (47.3) 0.900 0.016 Heart failure (%) 181 (17.9) 39 (19.4) 0.695 0.038 Shock (%) 356 (35.3) 83 (41.3) 0.124 0.124 Chronic pulmonary disease (%) 214 (21.2) 35 (17.4) 0.263 0.096 Respiratory failure (%) 370 (36.7) 86 (42.8) 0.120 0.125 Renal disease (%) 198 (19.6) 39 (19.4) 1.000 0.006 Renal failure (%) 479 (47.5) 123 (61.2) 0.001 0.278 Cirrhosis (%) 124 (12.3) 22 (10.9) 0.678 0.042 Diabetes (%) 275 (27.3) 104 (51.7) <0.001 0.517 Severity of illness SOFA 5.00 [3.00, 9.00] 5.00 [2.00, 8.00] 0.178 0.125 SAPS-Ⅱ 35.00 [25.00, 47.00] 33.00 [23.00, 44.00] 0.031 0.194 Charlson comorbidity index 4.14 (2.97) 4.11 (3.03) 0.912 0.008 Interventions Vasopressor use (%) 308 (30.5) 66 (32.8) 0.573 0.050 MV (%) 433 (42.9) 82 (40.8) 0.634 0.043 Insulin (%) 278 (27.6) 123 (61.2) <0.001 0.720 Prognosis 28-day mortality (%) 149 (14.8) 18 (9.0) 0.038 0.180 90-day mortality (%) 230 (22.8) 29 (14.4) 0.011 0.216 365-day mortality (%) 284 (28.1) 48 (23.9) 0.250 0.097 Data are presented as mean [IQR] for continuous variables and number (%) for categorical variables. Abbreviation: HbA1c, glycated hemoglobin. BUN, blood urea nitrogen. ALT, alanine transaminase. AST, aspartate transferase. RBC (×10³/µL), red blood cell. WBC (×10³/µL), white blood cell. SOFA, Sequential Organ Failure Assessment. SAPS-Ⅱ, Simplified Acute Physiology Score Ⅱ. MV, mechanical ventilation. Patients in the HbA1c measurement group were generally younger and exhibited better liver function compared to the non-measurement group. The measurement group had higher admission blood glucose levels [mean 135.81 mg/dL (SD 52.73) vs. 116.82 mg/dL (SD 42.30), p<0.001], a higher prevalence of diabetes (51.7% vs. 27.3%, p<0.001), and a higher incidence of renal failure (61.2% vs. 47.5%, p=0.001). Insulin treatment during hospitalization was more common in the measurement group (61.2% vs. 27.6%). The HbA1c measurement group had significantly lower mortality rates at both 28 days (9.0% vs. 14.8%, p=0.038) and 90 days (14.4% vs. 22.8%, p=0.011). After PSM( Table 2 ), the difference in insulin use between groups narrowed but remained statistically significant (60.9% vs. 39.1%, p<0.001). On the first day of ICU admission, when 55 patients (31.6%) in the measurement group had already undergone HbA1c testing, measurement group exhibited lower disease severity scores. Notably, the short-term mortality advantage of the HbA1c measurement group persisted after PSM. Table 2. Baseline characteristics of cohort after PSM Matched cohort Non-measurement group Measurement group P value SMD N = 174 N = 174 Basic information Age (years) 55.84 [45.70, 66.61] 55.32 [44.04, 67.26] 0.814 0.036 Sex (%) Female 70 (40.2) 63 (36.2) 0.508 0.083 Male 104 (59.8) 111 (63.8) Weight (kg) 80.90 [70.05, 97.22] 83.00 [68.20, 100.57] 0.981 0.018 Race (%) 0.772 0.144 White 92 (52.9) 91 (52.3) Unknown 33 (19.0) 26 (14.9) Other 23 (13.2) 26 (14.9) Black 21 (12.1) 23 (13.2) Asian 5 (2.9) 8 (4.6) smoking history (%) Current use 32 (18.4) 32 (18.4) 0.818 0.104 Former use 23 (13.2) 26 (14.9) Never used 32 (18.4) 37 (21.3) Unknown 87 (50.0) 79 (45.4) alcohol_abuse (%) 21 (12.1) 18 (10.3) 0.734 0.055 Laboratory tests HbA1c (%) 0.00 [0.00, 0.00] 6.00 [5.50, 7.45] <0.001 3.898 BUN (mg/dl) 20.00 [12.25, 40.00] 20.50 [11.00, 32.75] 0.122 0.186 Calcium (mg/dl) 8.25 [7.50, 8.80] 8.30 [7.60, 8.80] 0.769 0.006 Creatinine (mg/dL) 1.20 [0.80, 2.08] 1.10 [0.72, 1.80] 0.244 0.177 Glucose (mg/dL) 133.25 (52.54) 130.33 (49.57) 0.594 0.057 ALT (U/L) 47.50 [23.25, 134.00] 41.50 [19.00, 92.75] 0.097 0.038 AST (U/L) 475.49 (1785.10) 349.40 (1982.67) 0.533 0.067 Bilirubin total (mg/dL) 1.10 [0.50, 2.50] 1.00 [0.50, 1.80] 0.181 0.074 RBC (×10³/µL) 3.90 [3.25, 4.46] 3.86 [3.36, 4.52] 0.572 0.060 WBC (×10³/µL) 10.75 [7.70, 17.17] 11.65 [8.43, 15.30] 0.635 0.014 Platelet (×10³/µL) 175.00 [123.75, 254.50] 195.50 [141.50, 261.25] 0.142 0.035 Hemoglobin (g/dL) 11.75 [10.00, 13.47] 11.75 [10.10, 13.70] 0.769 0.016 Comorbidities and complications Hypertension (%) 80 (46.0) 82 (47.1) 0.914 0.023 Heart failure (%) 32 (18.4) 30 (17.2) 0.889 0.030 Shock (%) 70 (40.2) 70 (40.2) 1.000 <0.001 Chronic pulmonary disease (%) 36 (20.7) 31 (17.8) 0.587 0.073 Respiratory failure (%) 81 (46.6) 72 (41.4) 0.388 0.104 Renal disease (%) 41 (23.6) 31 (17.8) 0.234 0.142 Renal failure (%) 112 (64.4) 99 (56.9) 0.188 0.153 Cirrhosis (%) 24 (13.8) 18 (10.3) 0.411 0.106 Diabetes (%) 80 (46.0) 81 (46.6) 1.000 0.012 Severity of illness SOFA 6.71 (4.48) 5.44 (4.14) 0.006 0.294 SAPS-Ⅱ 38.85 (18.54) 34.74 (15.52) 0.025 0.241 Charlson comorbidity index 4.14 (3.26) 4.05 (2.92) 0.769 0.032 Interventions Vasopressor use (%) 58 (33.3) 57 (32.8) 1.000 0.012 MV (%) 89 (51.1) 72 (41.4) 0.085 0.197 Insulin (%) 68 (39.1) 106 (60.9) <0.001 0.448 Prognosis 28-day mortality (%) 30 (17.2) 15 (8.6) 0.025 0.259 90-day mortality (%) 45 (25.9) 25 (14.4) 0.011 0.290 365-day mortality (%) 55 (31.6) 40 (23.0) 0.092 0.194 Data are presented as mean [IQR] for continuous variables and number (%) for categorical variables. Abbreviation: HbA1c, glycated hemoglobin. BUN, blood urea nitrogen. ALT, alanine transaminase. AST, aspartate transferase. RBC (×10³/µL), red blood cell. WBC (×10³/µL), white blood cell. SOFA, Sequential Organ Failure Assessment. SAPS-Ⅱ, Simplified Acute Physiology Score Ⅱ. MV, mechanical ventilation. HbA1c measurement is associated with mortality Among the 348 patients in the propensity-matched cohort, 45 (12.9%), 70 (20.1%), and 95 (27.3%) died at 28 days, 90 days, and 365 days following admission, respectively. Survival analysis, performed using the Kaplan-Meier method and log-rank test, revealed a significant survival benefit for the measurement group at all pre-specified time points (28-day: P= 0.013; 90-day: P= 0.0054; 1-year: P= 0.0091; Figure 2 ). Cox proportional hazards regression confirmed that HbA1c measurement was independently associated with improved survival outcomes. Measurement was identified as a significant protective factor across all models: in the unadjusted model, the hazard ratio (HR) was 0.62 (95% CI, 0.43-0.89; p = 0.009), and in the fully adjusted model, the HR was 0.45 (95% CI, 0.30-0.69; p < 0.001) ( Figure 3 ). CMA indicated that intensified insulin use in the HbA1c measurement group was associated with an increased risk of mortality ( Table 3 ). Table 3. Causal mediation analysis for insulin use. Estimate Lower Upper P value Controlled direct effect 0.5825525 0.3962124 0.8345693 0.002 Natural direct effect 0.5825525 0.3962124 0.8345693 0.002 Natural indirect effect 1.1080589 1.0144937 1.2363791 0.018 Total effect 0.6455025 0.4318477 0.899811 0.006 Proportion mediated(%) -0.177575 -0.894697 -0.019675 0.024 Sensitivity Analysis To account for potential confounding by early mortality, we excluded patients who died within 48 hours of admission, as interventions are unlikely to influence acute deaths. This exclusion did not materially alter the association between HbA1c measurement and improved survival outcomes (Sfigure 1A) . Additionally, when stratified by follow-up duration, the protective effect of HbA1c measurement was more pronounced at 28 and 90 days, suggesting that HbA1c assessment primarily improves short-term prognosis (Sfigure 1B-C) . Discussion This study demonstrates for the first time that HbA1c measurement is independently associated with significantly lower all-cause mortality in patients with AP. This association remained robust after rigorous adjustment for potential confounding variables. However, CMA revealed that although measurement was associated with improved patient outcomes, the resulting aggressive insulin therapy strategy paradoxically increased mortality risk. The pancreas serves both exocrine and endocrine functions, with the latter playing a critical role in glucose homeostasis. Pancreatic inflammation in AP often leads to dysregulation of glucose metabolism. Distinguishing between transient stress-induced hyperglycemia and pre-existing glucose abnormalities in patients with AP is clinically challenging. Meta-analyses indicate that approximately 23% of AP survivors develop diabetes mellitus (DM) within three years post-discharge, further underscoring the close relationship between AP and glucose dysregulation[22, 23]. Epidemiological data show a continued rise in the global prevalence of diabetes[24, 25]. Among patients with AP, 12% to 25% have pre-existing DM[26–29]. Notably, pre-existing diabetes has been associated with increased AP severity, suggesting a higher prevalence of diabetes among severe cases[30]. HbA1c levels are typically classified as follows: <5.7% (normal), 5.7% to 6.4% (prediabetes), and ≥6.5% (diagnostic for diabetes mellitus)[31]. In the measurement group, the median HbA1c level was 6.10% (IQR, 5.60%–8.30%), which is significantly elevated compared to normal reference ranges. Analysis revealed that 56 patients had HbA1c levels in the prediabetes range (5.7%–6.4%), while a higher proportion (n=86) had levels above 6.4%. According to ICD-9 or ICD-10 criteria, the prevalence of diabetes mellitus was 51.7% in the measurement group and 27.3% in the non-measurement group. Therefore, early detection of dysglycemia in patients with AP is crucial, as serious diabetes-related complications such as diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), and diabetic nephropathy can be life-threatening. While previous reviews have advocated for HbA1c testing in patients with AP without substantial evidence, our retrospective cohort study provides definitive evidence supporting its clinical utility[32]. Previous studies have examined the prognostic value of HbA1c and blood glucose levels in patients with AP[11, 12, 18–20, 33]. Our findings suggest that HbA1c measurement may offer clinical value beyond prognostication. Clinicians may implement various proactive measures to improve patient outcomes based on HbA1c levels, although this causal relationship remains unverified in our study. For instance, by providing insight into patients' long-term glycemic status, HbA1c enables clinicians to differentiate between acute and chronic hyperglycemia, facilitating more tailored glucose management strategies. Furthermore, HbA1c can help identify undiagnosed diabetes, particularly in the setting of pancreatic endocrine dysfunction. However, in this study, only 16.6% of patients underwent measurement, indicating that HbA1c monitoring has not received adequate clinical attention in patients with AP. Although CMA revealed that increased insulin use associated with HbA1c measurement correlated with adverse outcomes, the overall benefit of measurement remained positive. This finding likely reflects survivor bias-patients with more severe metabolic disturbances were more likely to receive insulin therapy and inherently had poorer prognoses. Thus, the causal relationships among glycemic measurements, insulin use, and clinical outcomes require further investigation. This study has several limitations. First, the relatively small cohort size and wide time span may have introduced confounding factors, limiting our ability to establish causal relationships between measurements and clinical outcomes. Second, due to de-identification in the MIMIC database, patient admission years are unavailable, and eMAR data were only systematically collected after 2014. Consequently, insulin usage data before this period may have been misclassified. Additionally, the database's default one-year follow-up period restricted our analysis of long-term survival rates. Future research is needed to confirm the causal role of HbA1c measurement in improving AP outcomes and to better elucidate the underlying mechanisms. In conclusion, our findings highlight the potential clinical utility of routine HbA1c measurement in AP, particularly in intensive care settings. We recommend incorporating HbA1c assessment into standard laboratory tests for AP to facilitate earlier identification of diabetes mellitus and optimize management of glycemic abnormalities. Conclusions Our study shows that HbA1c measurement is significantly associated with decreased postoperative mortality in AP patients, suggesting its potential as a routine measurement in AP. Abbreviations HbA1c: Glycated hemoglobin AP: acute pancreatitis PSM: Propensity score matching CMA: Causal mediation analysis MIMIC-IV: Medical Information Mart for Intensive Care IV ICUs: intensive care units BUN: blood urea nitrogen ALT: alanine transaminase AST: aspartate transferase RBC ( × 10 ³ /µL): red blood cell WBC ( × 10 ³ /µL): white blood cell SOFA: Sequential Organ Failure Assessment SAPS- Ⅱ : Simplified Acute Physiology Score Ⅱ MV: mechanical ventilation Declarations Ethics approval and consent to participate The establishment of this database was approved by the Massachusetts Institute of Technology (Cambridge, MA) and Beth Israel Deaconess Medical Center (Boston, MA), and consent was obtained for the original data collection. Therefore, the ethical approval statement and the need for informed consent were waived for this manuscript. Consent for publication Not applicable Availability of data and materials The datasets were publicly accessible from the MIMIC-IV (version 3.1) database at https://physionet.org/content/mimiciv/3.1/. Competing interests The authors declare no competing interests. Funding This work is supported by the Key Research Projects of the Department of Science and Technology of Sichuan Province (Grant No.2023YFS0176) Author contributions K.N and R.W: conception and design, analysis and interpretation of the data; K.N: drafting of the article; R.W: critical revision of the article for important intellectual content; All authors: final approval of the article. Acknowledgements Not applicable References Sellers ZM, MacIsaac D, Yu H, Dehghan M, Zhang K-Y, Bensen R, et al. Nationwide Trends in Acute and Chronic Pancreatitis Among Privately Insured Children and Non-Elderly Adults in the United States, 2007–2014. Gastroenterology. 2018;155:469–e4781. https://doi.org/10.1053/j.gastro.2018.04.013 . 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Diabetes Care. 2021;44 Suppl 1:S15–33. https://doi.org/10.2337/dc21-S002 Han F, Shi X-L, Pan J-J, Wu K-Y, Zhu Q-T, Yuan C-C, et al. Elevated serum HbA1c level, rather than previous history of diabetes, predicts the disease severity and clinical outcomes of acute pancreatitis. BMJ Open Diabetes Res Care. 2023;11:e003070. https://doi.org/10.1136/bmjdrc-2022-003070 . Huang J, Shen Q, Tang W, Ji F, Liu Y, Zhou J, et al. The clinical significance of serum HbA1c to diagnose diabetes mellitus during acute pancreatitis. Expert Rev Gastroenterol Hepatol. 2023;17:385–94. https://doi.org/10.1080/17474124.2023.2192477 . Zhao X, Chang Mei H, Chen L, Jiang L, He M, Chen J, et al. An increased level of haemoglobin A1C predicts a poorer clinical outcome in patients with acute pancreatitis. Clin Endocrinol (Oxf). 2012;77:241–5. https://doi.org/10.1111/j.1365-2265.2011.04252.x . Wu J, Liang Y, Tang X, Rao Z, Li C, Pan X, et al. Ultra-early indicators of acute hypertriglyceridemic pancreatitis may influence treatment decision-making. Sci Rep. 2025;15:1572. https://doi.org/10.1038/s41598-025-85847-w . Johnson AEW, Bulgarelli L, Shen L, Gayles A, Shammout A, Horng S, et al. MIMIC-IV, a freely accessible electronic health record dataset. Sci Data. 2023;10:1. https://doi.org/10.1038/s41597-022-01899-x . Das SLM, Singh PP, Phillips ARJ, Murphy R, Windsor JA, Petrov MS. Newly diagnosed diabetes mellitus after acute pancreatitis: a systematic review and meta-analysis. Gut. 2014;63:818–31. https://doi.org/10.1136/gutjnl-2013-305062 . Zhi M, Zhu X, Lugea A, Waldron RT, Pandol SJ, Li L. Incidence of New Onset Diabetes Mellitus Secondary to Acute Pancreatitis: A Systematic Review and Meta-Analysis. Front Physiol. 2019;10:637. https://doi.org/10.3389/fphys.2019.00637 . Xie J, Wang M, Long Z, Ning H, Li J, Cao Y, et al. Global burden of type 2 diabetes in adolescents and young adults, 1990–2019: systematic analysis of the Global Burden of Disease Study 2019. BMJ. 2022;379:e072385. https://doi.org/10.1136/bmj-2022-072385 . GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023;402:203–34. https://doi.org/10.1016/S0140-6736(23)01301-6 . Shen H-N, Lu C-L, Li C-Y. Effect of diabetes on severity and hospital mortality in patients with acute pancreatitis: a national population-based study. Diabetes Care. 2012;35:1061–6. https://doi.org/10.2337/dc11-1925 . Goodger R, Singaram K, Petrov MS. Prevalence of Chronic Metabolic Comorbidities in Acute Pancreatitis and Its Impact on Early Gastrointestinal Symptoms during Hospitalization: A Prospective Cohort Study. Biomed Hub. 2021;6:111–7. https://doi.org/10.1159/000519826 . Nawaz H, O’Connell M, Papachristou GI, Yadav D. Severity and natural history of acute pancreatitis in diabetic patients. Pancreatology. 2015;15:247–52. https://doi.org/10.1016/j.pan.2015.03.013 . Brindise E, Elkhatib I, Kuruvilla A, Silva R. Temporal Trends in Incidence and Outcomes of Acute Pancreatitis in Hospitalized Patients in the United States From 2002 to 2013. Pancreas. 2019;48:169. https://doi.org/10.1097/MPA.0000000000001228 . Mikó A, Farkas N, Garami A, Szabó I, Vincze Á, Veres G, et al. Preexisting Diabetes Elevates Risk of Local and Systemic Complications in Acute Pancreatitis. Pancreas. 2018;47:917–23. https://doi.org/10.1097/MPA.0000000000001122 . American Diabetes Association. Standards of medical care in diabetes–2014. Diabetes Care. 2014;37(Suppl 1):S14–80. https://doi.org/10.2337/dc14-S014 . Mittal N, Oza VM, Muniraj T, Kothari TH. Diagnosis and Management of Acute Pancreatitis. Diagnostics (Basel). 2025;15:258. https://doi.org/10.3390/diagnostics15030258 . Balaban M, Balaban DV, Enache I, Nedelcu IC, Jinga M, Gheorghe C. Impact of Serum Glucose Levels on Outcomes in Acute Pancreatitis: A Retrospective Analysis. Med (Kaunas). 2024;60:856. https://doi.org/10.3390/medicina60060856 . Additional Declarations No competing interests reported. Supplementary Files Supplementaryinformation.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 07 May, 2026 Editor invited by journal 16 Apr, 2026 Editor assigned by journal 15 Apr, 2026 Submission checks completed at journal 15 Apr, 2026 First submitted to journal 13 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9409703","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":639417889,"identity":"e64e7d44-2bbc-4375-bc11-7036b2b8a0a2","order_by":0,"name":"Kang Nie","email":"","orcid":"","institution":"Sichuan University, West China Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kang","middleName":"","lastName":"Nie","suffix":""},{"id":639417890,"identity":"f808b4e4-d37d-4517-bd37-d50a5c3de5bd","order_by":1,"name":"Xiaoxi Xie","email":"","orcid":"","institution":"Sichuan University, West China Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaoxi","middleName":"","lastName":"Xie","suffix":""},{"id":639417891,"identity":"e40c0c7e-3786-48cd-bf4d-ad1c156dfad4","order_by":2,"name":"Shizhen Tu","email":"","orcid":"","institution":"Sichuan University, West China Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shizhen","middleName":"","lastName":"Tu","suffix":""},{"id":639417892,"identity":"459fc776-eb8f-42c1-bd6f-bb8737ccac68","order_by":3,"name":"Jinhang Gao","email":"","orcid":"","institution":"Sichuan University, West China Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jinhang","middleName":"","lastName":"Gao","suffix":""},{"id":639417893,"identity":"76abbbd4-a4a1-450b-b2bc-01e00b3070e8","order_by":4,"name":"Yufang Wang","email":"","orcid":"","institution":"Sichuan University, West China Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yufang","middleName":"","lastName":"Wang","suffix":""},{"id":639417894,"identity":"1d0c85ba-a51d-45bc-82db-f340fbf5305a","order_by":5,"name":"Rui Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYPACCX42Bh4gXSEhJ0+sFsk2sJYzFsaGDUTqkWwAaWFsq0hkOEBAqcHxs4dfV7ZZSPDxnz34uHKeRAJjA/PDRzfwaTmTl2Z5tk1Cgk0iL9nw7DaJPHYGNmPjHDxazA7kmBk2tknUsUnwmEk2bpMoZmzgYZPGq+X8G7AWCTb+M+Y/G+dIJDYcIKTlRo7xQ7AWhhwzxsYGIrTY33hjxthwDuSXHGPJhmMSxobNBPwi2Z9j/LGhrE5Cvv+M4ceGmjo5efbmh4/xaQECNglUPjN+5WAlHwirGQWjYBSMghENABA5RSNusu/TAAAAAElFTkSuQmCC","orcid":"","institution":"Sichuan University, West China Hospital","correspondingAuthor":true,"prefix":"","firstName":"Rui","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2026-04-14 02:53:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9409703/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9409703/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109405664,"identity":"ae02f732-dd78-40d6-8ae7-3fa6ca7ea743","added_by":"auto","created_at":"2026-05-17 13:19:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56330,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of patients selection. AP: acute pancreatitis; MIMIC-IV: Medical Information Mart for Intensive Care IV; ICU: intensive care unit; Measurement: HbA1c measurement.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9409703/v1/a433fdef18a8ccda43178cf0.png"},{"id":109332669,"identity":"a92d1ede-ee7b-4111-b20c-755342d92a98","added_by":"auto","created_at":"2026-05-15 16:21:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":172474,"visible":true,"origin":"","legend":"\u003cp\u003e28-day, 90-day and 1-year KM survival curve of measurement group and non-measurement group. P: log-rank p value.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9409703/v1/518eb2eb598cfae7c4c18381.png"},{"id":109332668,"identity":"9f7cc7ad-8c38-4012-8aff-62bacd4e88db","added_by":"auto","created_at":"2026-05-15 16:21:14","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":2118820,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryinformation.docx","url":"https://assets-eu.researchsquare.com/files/rs-9409703/v1/0f44fa16f3f049059cf366f6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"HbA1c measurement is associated with optimizing outcomes in acute pancreatitis: a retrospective study","fulltext":[{"header":"Background","content":"\u003cp\u003eAcute pancreatitis (AP) is one of the most common and severe gastrointestinal conditions leading to hospital admission in the United States, with an estimated incidence of 110 to 140 cases per 100,000 population and accounting for over 300,000 emergency department visits annually[\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Approximately 80% of patients present with a mild, self-limiting course and are typically discharged within several days[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, about 20% develop severe acute pancreatitis (SAP), which is associated with a mortality rate of approximately 20%[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Current risk stratification tools and clinical indicators for AP remain unsatisfactory[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], likely due to the complexity of clinical presentations and patient heterogeneity.\u003c/p\u003e \u003cp\u003eAbnormal glucose metabolism is frequently observed in patients with AP, potentially due to stress-related hyperglycemia and pancreatic dysfunction. Elevated blood glucose levels have been correlated with increased disease severity in AP[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Moreover, administration of glucose-containing fluids has been linked to higher risks of adverse outcomes in patients with AP [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], underscoring the importance of glucose monitoring and management in this population.\u003c/p\u003e \u003cp\u003eGlycated hemoglobin (HbA1c) is a biomarker reflecting average glucose levels over the preceding two to three months[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Compared to other glycemic markers, HbA1c demonstrates lower intra-individual variability, greater pre-analytical stability, and is less affected by acute stress, dietary changes, or intercurrent illness[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Previous studies have suggested that HbA1c may predict poorer clinical outcomes and aid in diagnosing diabetes mellitus among patients with AP [\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Beyond its diagnostic and prognostic value, HbA1c measurement could influence therapeutic decisions, particularly in guiding glycemic control strategies. However, there is currently insufficient evidence to support the routine inclusion of HbA1c as a standard laboratory parameter for patients with AP.\u003c/p\u003e \u003cp\u003eThis study aimed to investigate the impact of HbA1c measurement and related therapeutic interventions on all-cause mortality in patients with AP, and to assess the necessity of routine HbA1c testing in AP management.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Source\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective cohort study using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, a large, publicly available critical care database in the United States. MIMIC-IV contains detailed records for patients admitted to intensive care units (ICUs) or the emergency department between 2008 and 2022[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. All data are de-identified to protect patient privacy, and thus the use of this dataset was exempt from institutional review board (IRB) approval and the requirement for informed consent. Access to MIMIC-IV requires completion of the National Institutes of Health (NIH) online course on data use. The first author, Kang Nie, successfully completed the necessary training and was granted access (Certification Record ID: 65828193).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe study included patients diagnosed with AP using International Classification of Diseases, 9th and 10th Revision (ICD-9 and ICD-10) codes. Exclusion criteria were: (1) patients not admitted to the ICU (n\u0026thinsp;=\u0026thinsp;5,810); (2) non-first-time ICU admissions (n\u0026thinsp;=\u0026thinsp;420); (3) age younger than 18 years (n\u0026thinsp;=\u0026thinsp;0); (4) insufficient clinical data (n\u0026thinsp;=\u0026thinsp;70). After applying these criteria, 1,210 patients were included in the final analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eVariable Extraction\u003c/h3\u003e\n\u003cp\u003eData were extracted using PostgreSQL (version 17.1) and Navicat Premium (version 17) via structured query language (SQL). The primary exposure variable was HbA1c measurement during hospitalization. Demographic characteristics included age, sex, weight, race, smoking history, alcohol abuse, and all-cause mortality.\u003c/p\u003e \u003cp\u003eLaboratory data included admission blood glucose, blood urea nitrogen (BUN), calcium, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, hemoglobin, red blood cell (RBC) count, white blood cell (WBC) count, and platelet count. Severity scores obtained within the first 24 hours of ICU admission included the Sequential Organ Failure Assessment (SOFA) score and the Simplified Acute Physiology Score II (SAPS II). Therapeutic interventions recorded were vasopressor use, mechanical ventilation, and insulin administration.\u003c/p\u003e \u003cp\u003eComorbidities and complications were identified using ICD-9 and ICD-10 codes, including hypertension, heart failure, shock, chronic pulmonary disease, respiratory failure, renal disease, renal failure, cirrhosis, diabetes, and the Charlson comorbidity index. For variables with multiple records, the earliest value was selected for analysis.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are presented as means with standard deviations (SD) for normally distributed data, and medians with interquartile ranges (IQR) for non-normally distributed data. Categorical variables are summarized as counts and percentages. Group comparisons were performed using one-way analysis of variance (ANOVA) for normally distributed continuous variables, the Kruskal\u0026ndash;Wallis test for non-normally distributed continuous variables, and the chi-square (χ\u0026sup2;) test for categorical variables.\u003c/p\u003e \u003cp\u003eTo minimize potential confounding and balance baseline differences between groups, propensity score matching (PSM) was employed. Propensity scores were estimated using a multivariate logistic regression model incorporating variables associated with the likelihood of undergoing HbA1c measurement. One-to-one nearest neighbor matching was conducted with a caliper width of 0.05. Standardized mean differences (SMDs) were calculated to assess covariate balance after matching, with an SMD\u0026thinsp;\u0026lt;\u0026thinsp;0.1 indicating good balance.\u003c/p\u003e \u003cp\u003eSurvival analysis was performed using Kaplan\u0026ndash;Meier curves and Cox proportional hazards models to compare mortality outcomes between groups after PSM. Cox models were adjusted for demographic characteristics, laboratory data, severity scores, comorbidities, complications, and therapeutic interventions.\u003c/p\u003e \u003cp\u003eCausal mediation analysis (CMA) was conducted to explore whether the effect of HbA1c measurement on mortality was mediated by intermediate variables. A logistic regression model assessed mediation effects, while a Cox proportional hazards model served as the outcome model. Direct Counterfactual Imputation was applied, with 1,000 bootstrap samples used to estimate confidence intervals. Sensitivity analyses were performed by excluding patients who experienced early mortality (acute death) and by applying different censoring times prior to Cox regression analysis. All statistical analyses were performed using R software (version 4.4.2). A two-tailed \u003cem\u003eP\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf 5,810 hospitalization records reviewed, 1,210 patients met the inclusion criteria and were included in the final analysis (\u003cstrong\u003eFigure 1\u003c/strong\u003e). HbA1c was measured in 201 patients (16.6%), with a median value of 6.10% (IQR, 5.60%\u0026ndash;8.30%). Baseline characteristics of the HbA1c measurement and non-measurement groups are summarized in \u003cstrong\u003eTable 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Baseline characteristics of original cohort\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" colspan=\"5\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOriginal cohort\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-measurement group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeasurement group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSMD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eN = 1009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eN = 201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBasic information\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e60.23 [47.56, 73.83]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e54.37 [42.83, 66.91]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.306\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eSex (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e447 (44.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e72 (35.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e562 (55.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e129 (64.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e81.20 [70.00, 98.20]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e84.00 [68.70, 102.30]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eRace (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.437\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e673 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e93 (46.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e108 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e33 (16.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e104 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e29 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e92 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e38 (18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAsian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e32 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e8 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003esmoking history (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eCurrent use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e140 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e42 (20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eFormer use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e160 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e29 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNever used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e222 (22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e39 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e487 (48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e91 (45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ealcohol_abuse (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e113 (11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e21 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory tests\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eHbA1c (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e0.00 [0.00, 0.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e6.10 [5.60, 8.30]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e3.922\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBUN (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e20.00 [12.00, 34.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e21.00 [12.00, 33.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eCalcium (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e8.10 [7.50, 8.70]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e8.30 [7.70, 8.90]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eCreatinine (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e1.00 [0.70, 1.80]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.20 [0.80, 1.80]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eGlucose (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e116.82 (42.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e135.81 (52.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.397\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eALT (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e47.00 [25.00, 142.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e42.00 [19.00, 88.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAST (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e69.00 [34.00, 179.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e54.00 [27.00, 124.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBilirubin total (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e1.10 [0.60, 2.80]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0.90 [0.40, 1.80]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eRBC (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e3.72 [3.20, 4.30]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e3.85 [3.32, 4.54]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.250\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eWBC (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e11.90 [7.90, 17.50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e11.60 [8.40, 15.30]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.153\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePlatelet (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e189.00 [131.00, 269.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e198.00 [143.00, 268.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eHemoglobin (g/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e11.30 [9.60, 13.10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e11.80 [10.10, 13.80]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.193\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities and complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eHypertension (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e469 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e95 (47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eHeart failure (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e181 (17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e39 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.695\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eShock (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e356 (35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e83 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eChronic pulmonary disease (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e214 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e35 (17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eRespiratory failure (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e370 (36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e86 (42.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eRenal disease (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e198 (19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e39 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eRenal failure (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e479 (47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e123 (61.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.278\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eCirrhosis (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e124 (12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e22 (10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eDiabetes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e275 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e104 (51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.517\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeverity of illness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eSOFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e5.00 [3.00, 9.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e5.00 [2.00, 8.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eSAPS-Ⅱ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e35.00 [25.00, 47.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e33.00 [23.00, 44.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eCharlson comorbidity index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e4.14 (2.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e4.11 (3.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterventions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eVasopressor use (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e308 (30.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e66 (32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eMV (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e433 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e82 (40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.634\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eInsulin (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e278 (27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e123 (61.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.720\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrognosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e28-day mortality (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e149 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e18 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e90-day mortality (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e230 (22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e29 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e365-day mortality (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e284 (28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e48 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as mean\u0026thinsp;[IQR] for continuous variables and number (%) for categorical variables.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviation:\u0026nbsp;\u003c/strong\u003eHbA1c, glycated hemoglobin. BUN, blood urea nitrogen. ALT, alanine transaminase. AST, aspartate transferase. RBC (\u0026times;10\u0026sup3;/\u0026micro;L), red blood cell. WBC (\u0026times;10\u0026sup3;/\u0026micro;L), white blood cell. SOFA, Sequential Organ Failure Assessment. SAPS-Ⅱ, Simplified Acute Physiology Score Ⅱ. MV, mechanical ventilation.\u003c/p\u003e\n\u003cp\u003ePatients in the HbA1c measurement group were generally younger and exhibited better liver function compared to the non-measurement group. The measurement group had higher admission blood glucose levels [mean 135.81 mg/dL (SD 52.73) vs. 116.82 mg/dL (SD 42.30), p\u0026lt;0.001], a higher prevalence of diabetes (51.7% vs. 27.3%, p\u0026lt;0.001), and a higher incidence of renal failure (61.2% vs. 47.5%, p=0.001). Insulin treatment during hospitalization was more common in the measurement group (61.2% vs. 27.6%). The HbA1c measurement group had significantly lower mortality rates at both 28 days (9.0% vs. 14.8%, p=0.038) and 90 days (14.4% vs. 22.8%, p=0.011).\u003c/p\u003e\n\u003cp\u003eAfter PSM(\u003cstrong\u003eTable 2\u003c/strong\u003e), the difference in insulin use between groups narrowed but remained statistically significant (60.9% vs. 39.1%, p\u0026lt;0.001). On the first day of ICU admission, when 55 patients (31.6%) in the measurement group had already undergone HbA1c testing, measurement group exhibited lower disease severity scores. Notably, the short-term mortality advantage of the HbA1c measurement group persisted after PSM.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Baseline characteristics of cohort after PSM\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" colspan=\"5\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMatched cohort\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-measurement group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeasurement group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSMD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eN = 174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eN = 174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBasic information\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e55.84 [45.70, 66.61]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e55.32 [44.04, 67.26]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.814\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eSex (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e70 (40.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e63 (36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e104 (59.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e111 (63.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e80.90 [70.05, 97.22]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e83.00 [68.20, 100.57]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eRace (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.772\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e92 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e91 (52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e33 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e26 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e23 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e26 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e21 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e23 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAsian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e5 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e8 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003esmoking history (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eCurrent use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e32 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e32 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.818\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eFormer use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e23 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e26 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNever used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e32 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e37 (21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e87 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e79 (45.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ealcohol_abuse (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e21 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e18 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory tests\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eHbA1c (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e0.00 [0.00, 0.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e6.00 [5.50, 7.45]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e3.898\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBUN (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e20.00 [12.25, 40.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e20.50 [11.00, 32.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eCalcium (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e8.25 [7.50, 8.80]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e8.30 [7.60, 8.80]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.769\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eCreatinine (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e1.20 [0.80, 2.08]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.10 [0.72, 1.80]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.177\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eGlucose (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e133.25 (52.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e130.33 (49.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.594\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eALT (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e47.50 [23.25, 134.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e41.50 [19.00, 92.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAST (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e475.49 (1785.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e349.40 (1982.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBilirubin total (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e1.10 [0.50, 2.50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.00 [0.50, 1.80]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eRBC (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e3.90 [3.25, 4.46]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e3.86 [3.36, 4.52]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.572\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eWBC (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e10.75 [7.70, 17.17]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e11.65 [8.43, 15.30]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.635\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePlatelet (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e175.00 [123.75, 254.50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e195.50 [141.50, 261.25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eHemoglobin (g/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e11.75 [10.00, 13.47]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e11.75 [10.10, 13.70]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.769\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities and complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eHypertension (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e80 (46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e82 (47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eHeart failure (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e32 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e30 (17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.889\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eShock (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e70 (40.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e70 (40.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eChronic pulmonary disease (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e36 (20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e31 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eRespiratory failure (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e81 (46.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e72 (41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eRenal disease (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e41 (23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e31 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eRenal failure (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e112 (64.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e99 (56.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.153\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eCirrhosis (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e24 (13.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e18 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eDiabetes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e80 (46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e81 (46.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeverity of illness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eSOFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e6.71 (4.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e5.44 (4.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.294\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eSAPS-Ⅱ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e38.85 (18.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e34.74 (15.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eCharlson comorbidity index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e4.14 (3.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e4.05 (2.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.769\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterventions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eVasopressor use (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e58 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e57 (32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eMV (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e89 (51.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e72 (41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eInsulin (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e68 (39.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e106 (60.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrognosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e28-day mortality (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e30 (17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e15 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e90-day mortality (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e45 (25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e25 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.290\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e365-day mortality (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e55 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e40 (23.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as mean\u0026thinsp;[IQR] for continuous variables and number (%) for categorical variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviation:\u0026nbsp;\u003c/strong\u003eHbA1c, glycated hemoglobin. BUN, blood urea nitrogen. ALT, alanine transaminase. AST, aspartate transferase. RBC (\u0026times;10\u0026sup3;/\u0026micro;L), red blood cell. WBC (\u0026times;10\u0026sup3;/\u0026micro;L), white blood cell. SOFA, Sequential Organ Failure Assessment. SAPS-Ⅱ, Simplified Acute Physiology Score Ⅱ. MV, mechanical ventilation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHbA1c measurement is associated with mortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 348 patients in the propensity-matched cohort, 45 (12.9%), 70 (20.1%), and 95 (27.3%) died at 28 days, 90 days, and 365 days following admission, respectively. Survival analysis, performed using the Kaplan-Meier method and log-rank test, revealed a significant survival benefit for the measurement group at all pre-specified time points (28-day: P= 0.013; 90-day: P= 0.0054; 1-year: P= 0.0091; \u003cstrong\u003eFigure 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eCox proportional hazards regression confirmed that HbA1c measurement was independently associated with improved survival outcomes. Measurement was identified as a significant protective factor across all models: in the unadjusted model, the hazard ratio (HR) was 0.62 (95% CI, 0.43-0.89; p = 0.009), and in the fully adjusted model, the HR was 0.45 (95% CI, 0.30-0.69; p \u0026lt; 0.001) (\u003cstrong\u003eFigure 3\u003c/strong\u003e). CMA indicated that intensified insulin use in the HbA1c measurement group was associated with an increased risk of mortality (\u003cstrong\u003eTable 3\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eCausal mediation analysis for insulin use.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"474\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControlled direct effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.5825525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.3962124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.8345693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNatural direct effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.5825525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.3962124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.8345693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNatural indirect effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.1080589\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.0144937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.2363791\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.6455025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.4318477\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.899811\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProportion mediated(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.177575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.894697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.019675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eSensitivity Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo account for potential confounding by early mortality, we excluded patients who died within 48 hours of admission, as interventions are unlikely to influence acute deaths. This exclusion did not materially alter the association between HbA1c measurement and improved survival outcomes\u003cstrong\u003e\u0026nbsp;(Sfigure 1A)\u003c/strong\u003e. Additionally, when stratified by follow-up duration, the protective effect of HbA1c measurement was more pronounced at 28 and 90 days, suggesting that HbA1c assessment primarily improves short-term prognosis\u003cstrong\u003e\u0026nbsp;(Sfigure 1B-C)\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrates for the first time that HbA1c measurement is independently associated with significantly lower all-cause mortality in patients with AP. This association remained robust after rigorous adjustment for potential confounding variables. However, CMA revealed that although measurement was associated with improved patient outcomes, the resulting aggressive insulin therapy strategy paradoxically increased mortality risk.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe pancreas serves both exocrine and endocrine functions, with the latter playing a critical role in glucose homeostasis. Pancreatic inflammation in AP often leads to dysregulation of glucose metabolism. Distinguishing between transient stress-induced hyperglycemia and pre-existing glucose abnormalities in patients with AP is clinically challenging. Meta-analyses indicate that approximately 23% of AP survivors develop diabetes mellitus (DM) within three years post-discharge, further underscoring the close relationship between AP and glucose dysregulation[22, 23].\u003c/p\u003e\n\u003cp\u003eEpidemiological data show a continued rise in the global prevalence of diabetes[24, 25]. Among patients with AP, 12% to 25% have pre-existing DM[26–29]. Notably, pre-existing diabetes has been associated with increased AP severity, suggesting a higher prevalence of diabetes among severe cases[30]. HbA1c levels are typically classified as follows: \u0026lt;5.7% (normal), 5.7% to 6.4% (prediabetes), and\u0026nbsp;≥6.5% (diagnostic for diabetes mellitus)[31]. In the measurement group, the median HbA1c level was 6.10% (IQR, 5.60%–8.30%), which is significantly elevated compared to normal reference ranges. Analysis revealed that 56 patients had HbA1c levels in the prediabetes range (5.7%–6.4%), while a higher proportion (n=86) had levels above 6.4%. According to ICD-9 or ICD-10 criteria, the prevalence of diabetes mellitus was 51.7% in the measurement group and 27.3% in the non-measurement group. Therefore, early detection of dysglycemia in patients with AP is crucial, as serious diabetes-related complications such as diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), and diabetic nephropathy can be life-threatening.\u003c/p\u003e\n\u003cp\u003eWhile previous reviews have advocated for HbA1c testing in patients with AP without substantial evidence, our retrospective cohort study provides definitive evidence supporting its clinical utility[32]. Previous studies have examined the prognostic value of HbA1c and blood glucose levels in patients with AP[11, 12, 18–20, 33]. Our findings suggest that HbA1c measurement may offer clinical value beyond prognostication. Clinicians may implement various proactive measures to improve patient outcomes based on HbA1c levels, although this causal relationship remains unverified in our study. For instance, by providing insight into patients' long-term glycemic status, HbA1c enables clinicians to differentiate between acute and chronic hyperglycemia, facilitating more tailored glucose management strategies. Furthermore, HbA1c can help identify undiagnosed diabetes, particularly in the setting of pancreatic endocrine dysfunction. However, in this study, only 16.6% of patients underwent measurement, indicating that HbA1c monitoring has not received adequate clinical attention in patients with AP.\u003c/p\u003e\n\u003cp\u003eAlthough CMA revealed that increased insulin use associated with HbA1c measurement correlated with adverse outcomes, the overall benefit of measurement remained positive. This finding likely reflects survivor bias-patients with more severe metabolic disturbances were more likely to receive insulin therapy and inherently had poorer prognoses. Thus, the causal relationships among glycemic measurements, insulin use, and clinical outcomes require further investigation.\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. First, the relatively small cohort size and wide time span may have introduced confounding factors, limiting our ability to establish causal relationships between measurements and clinical outcomes. Second, due to de-identification in the MIMIC database, patient admission years are unavailable, and eMAR data were only systematically collected after 2014. Consequently, insulin usage data before this period may have been misclassified. Additionally, the database's default one-year follow-up period restricted our analysis of long-term survival rates. Future research is needed to confirm the causal role of HbA1c measurement in improving AP outcomes and to better elucidate the underlying mechanisms.\u003c/p\u003e\n\u003cp\u003eIn conclusion, our findings highlight the potential clinical utility of routine HbA1c measurement in AP, particularly in intensive care settings. We recommend incorporating HbA1c assessment into standard laboratory tests for AP to facilitate earlier identification of diabetes mellitus and optimize management of glycemic abnormalities.\u003c/p\u003e\n\n"},{"header":"Conclusions","content":"\u003cp\u003eOur study shows that HbA1c measurement is significantly associated with decreased postoperative mortality in AP patients, suggesting its potential as a routine measurement in AP.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eHbA1c:\u003c/strong\u003e Glycated hemoglobin\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAP:\u0026nbsp;\u003c/strong\u003eacute pancreatitis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePSM:\u003c/strong\u003e Propensity score matching\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCMA:\u0026nbsp;\u003c/strong\u003eCausal mediation analysis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMIMIC-IV:\u0026nbsp;\u003c/strong\u003eMedical Information Mart for Intensive Care IV\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICUs:\u003c/strong\u003e intensive care units\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBUN:\u0026nbsp;\u003c/strong\u003eblood urea nitrogen\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eALT:\u003c/strong\u003e alanine transaminase\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAST:\u003c/strong\u003e aspartate transferase\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRBC (\u003c/strong\u003e\u003cstrong\u003e\u0026times;\u003c/strong\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003cstrong\u003e\u0026sup3;\u003c/strong\u003e\u003cstrong\u003e/\u0026micro;L):\u003c/strong\u003e red blood cell\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWBC (\u003c/strong\u003e\u003cstrong\u003e\u0026times;\u003c/strong\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003cstrong\u003e\u0026sup3;\u003c/strong\u003e\u003cstrong\u003e/\u0026micro;L):\u003c/strong\u003e white blood cell\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSOFA:\u003c/strong\u003e Sequential Organ Failure Assessment\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSAPS-\u003c/strong\u003e\u003cstrong\u003eⅡ\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Simplified Acute Physiology Score\u0026nbsp;Ⅱ\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMV:\u003c/strong\u003e mechanical ventilation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe establishment of this database was approved by the Massachusetts Institute of Technology (Cambridge, MA) and Beth Israel Deaconess Medical Center (Boston, MA), and consent was obtained for the original data collection. Therefore, the ethical approval statement and the need for informed consent were waived for this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets were publicly accessible from the MIMIC-IV (version 3.1) database at https://physionet.org/content/mimiciv/3.1/.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work is supported by the Key Research Projects of the Department of Science and Technology of Sichuan Province (Grant No.2023YFS0176)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eK.N and R.W: conception and design, analysis and interpretation of the data; K.N: drafting of the article; R.W: critical revision of the article for important intellectual content; All authors: final approval of the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSellers ZM, MacIsaac D, Yu H, Dehghan M, Zhang K-Y, Bensen R, et al. 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Diagnostics (Basel). 2025;15:258. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/diagnostics15030258\u003c/span\u003e\u003cspan address=\"10.3390/diagnostics15030258\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBalaban M, Balaban DV, Enache I, Nedelcu IC, Jinga M, Gheorghe C. Impact of Serum Glucose Levels on Outcomes in Acute Pancreatitis: A Retrospective Analysis. Med (Kaunas). 2024;60:856. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/medicina60060856\u003c/span\u003e\u003cspan address=\"10.3390/medicina60060856\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":false,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Acute pancreatitis, ICU, HbA1c, Insulin","lastPublishedDoi":"10.21203/rs.3.rs-9409703/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9409703/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eGlycated hemoglobin (HbA1c), a biomarker reflecting long-term glucose metabolism, has been demonstrated to have predictive value for the prognosis of acute pancreatitis (AP) in previous studies. However, the prognostic benefit of measuring HbA1c has not yet been established.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eWe extracted data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database for patients with and without HbA1c testing. Propensity score matching (PSM) was used to improve comparability between the tested and control groups. Cox proportional hazards regression and Kaplan\u0026ndash;Meier survival analyses were performed to assess the association between HbA1c measurement and all-cause mortality. Causal mediation analysis (CMA) was conducted to evaluate the effect of insulin use on clinical outcomes.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eA total of 1,210 patients were included in this study, among whom 201 (17%) underwent HbA1c measurement. After PSM, 348 patients were included in the final analysis, with half of them receiving HbA1c measurement.The measurement group demonstrated significantly lower 28-day (8.6% vs 17.2%, p\u0026thinsp;=\u0026thinsp;0.025) and 90-day(14.4% vs 25.9%, p\u0026thinsp;=\u0026thinsp;0.011) mortality rates compared to controls. Multivariate Cox regression verified that HbA1c measurement independently correlates with all-cause mortality (HR\u0026thinsp;=\u0026thinsp;0.45, 95% CI: 0.30\u0026ndash;0.69, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Notably, insulin usage was significantly more common in the measurement group (60.9% vs 39.1%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, causal mediation analysis revealed that increased insulin administration was associated with elevated mortality risk (p\u0026thinsp;=\u0026thinsp;0.024).\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eHbA1c testing was associated with reduced all-cause mortality in patients with AP. Routine HbA1c measurement may have a positive impact on clinical outcomes in these patients.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e","manuscriptTitle":"HbA1c measurement is associated with optimizing outcomes in acute pancreatitis: a retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-15 16:21:10","doi":"10.21203/rs.3.rs-9409703/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-05-07T06:27:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-16T05:32:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-15T07:38:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-15T07:38:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2026-04-14T02:47:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"37a33d6b-0a59-4f55-a655-1aaf0eb90d15","owner":[],"postedDate":"May 15th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewersInvited","content":"30","date":"2026-05-07T06:27:36+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T16:21:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-15 16:21:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9409703","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9409703","identity":"rs-9409703","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}