High admission glucose levels predict worse short-term clinical outcome in non-diabetic patients with acute myocardial infraction: a retrospective observational study
High admission glucose levels predict worse short-term clinical outcome in non-diabetic patients with acute myocardial infraction: a retrospective observational study
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高入院血糖水平预示非糖尿病急性心肌梗死患者短期临床结果较差：一项回顾性观察研究
DOI：
10.1186/s12872-019-1140-1
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发表时间：
2019-07-04
影响因子：
2.1
通讯作者：
Li, Hong Wei
中科院分区：
文献类型：
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作者：
Ding, Xiao Song;Wu, Shan Shan;Li, Hong Wei
研究背景急性心肌梗死（AMI）患者常伴有入院时高血糖，这通常预示着非糖尿病患者的不良临床结局。方法回顾性分析1698例非糖尿病AMI患者，根据入院血糖水平分为3组（正常组≤140 mg/dL，中度高血糖组141-179 mg/dL，重度高血糖组≥180 mg/dL）。本研究的主要终点是全因住院死亡率。结果重度高血糖组各项心肌坏死标志物及Log NT-proBNP均显著高于其他2组，且两组间差异有统计学意义（P < 0. 05）。Logistic回归分析显示，年龄是非糖尿病AMI患者住院期间死亡率的独立预测因素（OR = 1.057，95%CI1.024 - 1.091，P < 0.001），N末端脑钠肽前体的对数（OR = 7.697，95%CI 3.810- 15.550，P < 0.001），心肌再灌注不足（OR = 7.654，95%CI2.109 - 27.779，P < 0.001）、经皮冠状动脉介入治疗（OR = 0.221，95%CI0.108 - 0.452，P < 0.001）和入院血糖（作为分类变量）。中度高血糖患者（OR = 1.186，95%CI 0.585- 2.408，P = .636）（OR = 4.595，95%CI 1.942-10.873，P= 0.001）与非糖尿病患者中AMI后存活的患者相比，有更高的全因住院死亡率。非糖尿病AMI患者入院时血糖水平升高，住院死亡风险显著增加，尤其是入院时血糖水平≥180 mg/dL的患者。入院时严重高血糖可作为非糖尿病AMI患者的前瞻性高危指标。
BackgroundPatients with acute myocardial infarction (AMI) often accompanied by admission hyperglycemia, which usually predicts a poor clinical outcomes for non-diabetes mellitus. Appropriate cut-point to identify high risk individuals in these patients remains controversial.MethodsOne thousand six hundred ninety-eight non-diabetes AMI patients in this retrospective study were divided into 3 groups according to admission glucose levels (euglycemia group≤140 mg/dL, moderate hyperglycemia group 141–179 mg/dL, severe hyperglycemia group≥180 mg/dL). The primary endpoint of this study was all-cause in-hospital mortality rate. In-hospital motality related risk factors was analyzed by multivariate binary logistic regression analyses.ResultsAll myocardial necrosis markers and Log NT-proBNP in severe hyperglycemia group were significantly higher than those in the other 2 groups. Logistic regression showed that independent predictors of the in-hospital mortality rate in non-diabetic patients with AMI were age (OR = 1.057, 95% CI 1.024–1.091,P< 0.001), logarithm of the N-terminal pro-brain natriuretic peptide (OR = 7.697, 95% CI 3.810–15.550,P< 0.001), insufficient myocardial reperfusion (OR = 7.654, 95% CI 2.109–27.779,P< 0.001), percutaneous coronary intervention (OR = 0.221, 95% CI 0.108–0.452,P< 0.001) and admission glucose (as categorical variable). Patients with moderate hyperglycemia (OR = 1.186, 95% CI 0.585–2.408,P= .636) and severe hyperglycemia (OR = 4.595, 95% CI 1.942–10.873,P= 0.001) had a higher all-cause in-hospital mortality rate compared with those with euglycemia after AMI in non-diabetic patients.ConclusionsThe all-cause in-hospital mortality risk increases remarkably as admission glucose levels elevated in non-diabetic patients with AMI, especially in patients with admission glucose levels ≥180 mg/dL. Severe admission hyperglycemia could be regarded as prospective high-risk marker for non-diabetic AMI patients.