Glucose and haemoglobin in the assessment of prognosis after first hospitalisation for heart failure
Glucose and haemoglobin in the assessment of prognosis after first hospitalisation for heart failure
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DOI：
10.1136/hrt.2005.080895
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发表时间：
2006-10-01
期刊：
影响因子：
5.7
通讯作者：
Squire, I. B.
中科院分区：
文献类型：
--
作者：
Newton, J. D.;Squire, I. B.
目的：在标准临床实践中，研究慢性心力衰竭（CHF）首次入院后不久测量的血浆血红蛋白和血糖浓度与预后的关系。
方法与结果：回顾了528例首次因CHF入院患者（43%为女性，平均年龄70岁）的住院病历。在随访期间（平均1257天，范围520 - 1800天），240例（45%）患者死亡。入院时，528例患者中有140例（27%），472例存活患者出院时有179例（38%）正在接受糖尿病治疗。39%的男性和43%的女性符合世界卫生组织的贫血标准。较低的血红蛋白（风险比0.879，95%置信区间（CI）0.828 - 0.933，p < 0.0001）和较高的血浆血糖（风险比1.034，95%CI 1.008 - 1.061，p = 0.009）与全因死亡率有单变量关联。在多变量分析中，与同性别血红蛋白正常的患者相比，血红蛋白低的患者风险比为1.415（95%CI 1.087 - 1.841，p = 0.010）。血红蛋白高达159 g/L时，全因死亡率呈线性下降，超过此值死亡率上升。血糖高于最高四分位数（>10mmol/L）是死亡率的独立预测因子（风险比1.966，95%CI 1.376 - 2.810，p = 0.0002）。在首次入院的存活者中，血糖与死亡率之间的关联是线性的，对于无糖尿病的患者这种关系更强。
结论：在CHF中，较低的血红蛋白和较高的血浆血糖与全因死亡率相关。无论糖尿病状况如何，较高的血糖都与死亡率相关。
Objective: To examine the relationship with outcome of plasma haemoglobin and glucose concentrations, measured soon after first hospital admission with chronic heart failure (CHF), in standard clinical practice.Methods and results: Hospital records of 528 patients (43% women, mean age 70 years) with first hospital admission for CHF were reviewed. During follow up (mean 1257 days, range 520-1800), 240 (45%) patients died. On admission, 140 of 528 (27%) and at discharge 179 of 472 survivors (38%) were receiving treatment for diabetes. World Health Organization criteria for anaemia were met by 39% of men and 43% of women. Lower haemoglobin (hazard ratio 0.879, 95% confidence interval (CI) 0.828 to 0.933, p < 0.0001) and higher plasma glucose (hazard ratio 1.034, 95% CI 1.008 to 1.061, p = 0.009) had univariate association with all-cause mortality. On multivariate analysis, compared with patients with a normal haemoglobin for their sex, hazard ratio was 1.415 (95% CI 1.087 to 1.841, p = 0.010) for those with low haemoglobin. All-cause mortality fell linearly for haemoglobin up to 159 g/l, above which mortality increased. Glucose above the highest quartile (> 10mmol/l) was an independent predictor of mortality (hazard ratio 1.966, 95% CI 1.376 to 2.810, p = 0.0002). In survivors of the index admission the association between glucose and mortality was linear, the relationship being stronger for patients without diabetes.Conclusions: Lower haemoglobin and higher plasma glucose are associated with all-cause mortality in CHF. Higher glucose is associated with mortality irrespective of diabetic status.