Prediction of acute metabolic complications in hospitalized elderly patients with type 2 diabetes using admission HbA1c and hypertension: a retrospective cohort study.

Abstract

Objective: To identify admission-based predictive indicators for in-hospital acute metabolic complications in elderly patients with type 2 diabetes mellitus (T2DM), and to develop and internally validate a simple predictive model for early risk stratification.

Methods: A total of 203 elderly inpatients with T2DM were included in this retrospective cohort study. According to the occurrence of acute metabolic complications during hospitalization, patients were divided into a complication group (n = 40) and a non-complication group (n = 163). All candidate predictive indicators were collected from admission medical records and laboratory test results obtained within 24 to 48 hours after admission. Univariate and multivariate logistic regression analyses were performed to screen for independent predictive factors. The model's discriminatory power was evaluated using the area under the receiver operating characteristic curve (AUC), and 1000 bootstrap resamplings were adopted for internal validation.

Results: The complication group had significantly higher admission HbA1c levels than the non-complication group (P<0.001), as well as a higher prevalence of hypertension (P = 0.002). Multivariate regression analysis verified that HbA1c (OR = 1.761, 95% CI: 1.44-2.15, P<0.001) and hypertension (OR = 3.904, 95% CI: 1.60-9.53, P = 0.003) were independent risk factors for in-hospital acute metabolic complications. The predictive model based on these two indicators exhibited good discriminatory performance, with an original AUC of 0.836. After bootstrap internal validation, the optimism-corrected AUC was 0.726, indicating acceptable stability of the model.

Conclusion: Elevated admission HbA1c and comorbid hypertension are independent predictive factors for in-hospital acute metabolic complications in elderly T2DM patients. This novel simple model has favorable predictive efficacy and stability, and it can serve as a feasible clinical tool for early risk stratification in elderly T2DM inpatients.