Study on the relationship of glycosylated hemoglobin variation index,islet cell function and related metabolic markers with clinical outcomes in type 2 diabetes mellitus patients with influenza virus pneumonia

Dou Yajing; Peng Chunxia; Zhou Yaguang; Liu Yanan; Li Song

doi:10.3969/j.issn.1002-1949.2025.06.009

Abstract：Objective To explore the relationship of glycosylated hemoglobin variation index,islet cell function and related metabolic markers with clinical outcomes in type 2 diabetes mellitus patients with influenza virus pneumonia.Methods All 240 type 2 diabetes mellitus patients with influenza virus pneumonia admitted to Civil Aviation General Hospital from January 2023 to April 2024 were included as the study subjects.167 patients(69.6％)were in the survival group and 73 patients(30.4％)were in the death group according to different prognosis.The statistically significant variables in the univariate analysis(P＜0.05)were included in the multivariate Logistic regression analysis,and the final variables were screened by the maximum likelihood ratio progression method to obtain independent predictors of the prognosis of type 2 diabetes mellitus patients with influenza virus pneumonia.A nomogram prediction model was constructed to predict the death risk of type 2 diabetes mellitus patients with influenza virus pneumonia based on the independent predictors.The differentiation evaluation index(C index)of the nomogram model was calculated,and the accuracy and predictive performance of the nomogram model was evaluated by goodness of fit(H-L)test and the receiver operating characteristic(ROC)curve.Results The results of the univariate analysis showed that there were statistically significant differences in age,PaO2,D-dimer,lung injury score,glycosylated hemoglobin variation index,homeostasis model assessment of insulin resistance(HOMA-IR),homeostasis model assessment β cell function(HOMA-β),fasting insulin and length of hospital stay of patients between the two groups(P＜0.05).After adjusting and correcting for confounding factors by multivariate Logistic regression analysis,glycosylated hemoglobin variation index,HOMA-β,fasting insulin were independent predictors of prognosis in type 2 diabetes mellitus patients with influenza virus pneumonia(P＜0.05).A nomogram prediction model was constructed to predict the death risk of type 2 diabetes mellitus patients with influenza virus pneumonia based on the independent factors combined with the influence weight.The results of H-L test showed that the predicted death risk of type 2 diabetes mellitus patients with influenza virus pneumonia was in good agreement with the actual observed value(P＞0.05).The ROC analysis results showed that the AUC of the nomogram prediction model was 0.894(95％CI 0.845-0.933).Conclusions The nomogram model based on glycosylated hemoglobin variation index,HOMA-β and fasting insulin can accurately predict the death risk of type 2 diabetes mellitus patients with influenza virus pneumonia.