Background Several guidelines have suggested alternative glycemic markers for hemoglobin A1c among older adults with limited life expectancy or multiple coexisting chronic illnesses. We evaluated associations between fructosamine, albumin-corrected fructosamine (AlbF), fasting plasma glucose (FPG), and mortality in the diabetic and nondiabetic subpopulations, and compared which marker better predicts mortality among participants aged 80 and older. Methods Included were 2 238 subjects from the Healthy Ageing and Biomarkers Cohort Study (2012–2018) and 207 participants had diabetes at baseline. Multivariable Cox proportional hazards regression models investigated the associations of fructosamine, AlbF, FPG, and all-cause, cardiovascular disease (CVD), and non-CVD mortality in the diabetic and nondiabetic subpopulations. Restricted cubic splines explored potential nonlinear relations. C-statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) evaluated the additive value of different glycemic markers to predict mortality. Results Overall, 1 191 deaths were documented during 6 793 person-years of follow-up. In the linear model, per unit increases of fructosamine, AlbF, and FPG were associated with a higher risk of mortality in nondiabetic participants, with hazard ratios of 1.02 (1.00, 1.05), 1.27 (1.14, 1.42), and 1.04 (0.98, 1.11) for all-cause mortality, and 1.04 (1.00, 1.07), 1.38 (1.19, 1.59), and 1.10 (1.01, 1.19) for non-CVD mortality, respectively. Comparisons indicated that AlbF better predicts all-cause and non-CVD mortality in nondiabetic participants with significant improvement in IDI and NRI. Conclusions Higher concentrations of fructosamine, AlbF, and FPG were associated with a higher risk of all-cause or non-CVD mortality among the very elderly where AlbF may constitute an alternative prospective glycemic predictor of mortality.

中文翻译：

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白蛋白校正的果糖胺可预测 80 岁或以上无糖尿病的高龄老人的全因和非 CVD 死亡率

背景 一些指南建议在预期寿命有限或同时患有多种慢性疾病的老年人中使用糖化血红蛋白的替代血糖标记物。我们评估了果糖胺、白蛋白校正果糖胺 (AlbF)、空腹血糖 (FPG) 与糖尿病和非糖尿病亚群死亡率之间的关联，并比较了哪种标记物能更好地预测 80 岁及以上参与者的死亡率。方法包括来自健康老龄化和生物标志物队列研究（2012-2018 年）的 2238 名受试者，其中 207 名参与者在基线时患有糖尿病。多变量 Cox 比例风险回归模型调查了糖尿病和非糖尿病亚群中果糖胺、AlbF、FPG 与全因、心血管疾病 (CVD) 和非 CVD 死亡率之间的关联。受限三次样条探索了潜在的非线性关系。C 统计、综合辨别改进 (IDI) 和净重新分类改进 (NRI) 评估了不同血糖标记物预测死亡率的附加值。结果 总体而言，在 6 793 人年的随访期间记录了 1 191 例死亡。在线性模型中，每单位果糖胺、AlbF 和 FPG 的增加与非糖尿病参与者的更高死亡风险相关，风险比为 1.02 (1.00, 1.05)、1.27 (1.14, 1.42) 和 1.04 (0.98,全因死亡率为 1.11)，非 CVD 死亡率分别为 1.04 (1.00, 1.07)、1.38 (1.19, 1.59) 和 1.10 (1.01, 1.19)。比较表明，AlbF 可以更好地预测非糖尿病参与者的全因死亡率和非 CVD 死亡率，IDI 和 NRI 有显着改善。