Decreased blood glucose at admission has a prognostic impact in patients with severely decompensated acute heart failure complicated with diabetes mellitus
Decreased blood glucose at admission has a prognostic impact in patients with severely decompensated acute heart failure complicated with diabetes mellitus
复制标题
入院时血糖下降对严重失代偿性急性心力衰竭并发糖尿病患者的预后有影响
作者：
A. Shirakabe;N. Hata;Nobuaki Kobayashi;Hirotake Okazaki;Masato Matsushita;Yusaku Shibata;Suguru Nishigoori;Saori Uchiyama;Kazutaka Kiuchi;F. Okajima;T. Otsuka;K. Asai;W. Shimizu
急性心力衰竭（AHF）中血糖水平降低对预后的影响尚未充分阐明。本研究对1234例AHF患者的数据进行了分析。入院时评估血糖（BG）水平。患者根据以下情况分组：是否患有糖尿病（DM），以及血糖水平≥200 mg/dl（血糖升高）或＜200 mg/dl（血糖降低）。血糖升高和降低的患者进一步分为另外三组：200 mg/ml≤BG＜300 mg/dl（轻度升高），300 mg/ml≤BG＜400 mg/dl（中度升高）和BG≥400 mg/ml（重度升高）；以及150 mg/ml≤BG＜200 mg/dl（轻度降低），100 mg/ml≤BG＜150 mg/dl（中度降低）和BG＜100 mg/ml（重度降低）。糖尿病患者的死亡率明显高于非糖尿病患者。血糖升高或降低的患者预后不同。在血糖升高的糖尿病患者中，重度升高的患者预后明显比中度和轻度升高的患者差。在血糖降低的糖尿病患者中，重度降低的患者预后明显比中度和轻度降低的患者差。多变量Cox回归模型显示，重度降低[风险比（HR）3.245，95%置信区间（CI）1.271 - 8.282]和重度升高（HR 2.300，95% CI 1.143 - 4.628）状态是糖尿病合并AHF患者365天死亡率的独立预测因素。糖尿病合并AHF患者的死亡率较高。此外，重度高血糖和低血糖都是急性心力衰竭合并糖尿病患者死亡率的独立预测因素。
The prognostic impact of a decreased blood glucose level in acute heart failure (AHF) has not been sufficiently clarified. The data from 1234 AHF patients were examined in the present study. The blood glucose (BG) levels were evaluated at admission. The patients were divided into groups based on the following: with or without diabetes mellitus (DM), and BG level ≥ 200 mg/dl (elevated BG) or < 200 mg/dl (decreased BG). The elevated and decreased BG patients were further divided into another three groups: 200 mg/ml ≤ BG < 300 mg/dl (mild-elevated), 300 mg/ml ≤ BG < 400 mg/dl (moderate-elevated) and BG ≥ 400 mg/ml (severe-elevated); and 150 mg/ml ≤ BG < 200 mg/dl (mild-decreased), 100 mg/ml ≤ BG < 150 mg/dl (moderate-decreased) and BG < 100 mg/ml (severe-decreased), respectively. The DM patients had a significantly poorer mortality than the non-DM patients. The prognosis was different between patients with elevated or decreased BG. In DM patients with elevated BG, the severe-elevated patients had a significantly poorer prognosis than moderate- and mild-elevated patients. In the DM patients with decreased BG, the severe-decreased patients had a significantly poorer prognosis than those moderate- and mild-decreased patients. The multivariate Cox regression model showed that a severe-decreased [hazard ratio (HR) 3.245, 95% confidence interval (CI) 1.271–8.282] and severe-elevated (HR 2.300, 95% CI 1.143–4.628) status were independent predictors of 365-day mortality in AHF patients with DM. The mortality was high among AHF patients with DM. Furthermore, both severe hyperglycemia and hypoglycemia were independent predictors of the mortality in patients with AHF complicated with DM.
影响因子：
37.8
作者：
Xu J;Zou MH
通讯作者：
Zou MH