Admission blood glucose level and mortality among hospitalized nondiabetic patients with heart failure
Admission blood glucose level and mortality among hospitalized nondiabetic patients with heart failure
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DOI：
10.1001/archinte.166.15.1613
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发表时间：
2006-08-14
影响因子：
--
通讯作者：
Leor, Jonathan
中科院分区：
文献类型：
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作者：
Barsheshet, Alon;Garty, Moshe;Leor, Jonathan
背景：心力衰竭（HF）非糖尿病患者入院血糖水平的意义尚不明确。我们在一大群因心力衰竭住院的患者中研究了入院血糖水平与预后之间可能存在的关联。
方法：我们分析了在一项前瞻性全国性调查期间住院的4102名心力衰竭患者的数据。本研究聚焦于1122名因急性心力衰竭或慢性心力衰竭急性加重而入院的急性心力衰竭非糖尿病患者亚组。
结果：入院血糖水平处于第三三分位数的患者院内死亡率（7.2%）是处于第一三分位数（3%）和第二三分位数（4%）患者的两倍（P = 0.02）。此外，死亡风险与入院血糖水平相关；血糖水平每升高18mg/dL（1mmol/L），院内死亡风险增加31%（校正优势比为1.31；95%置信区间为1.10 - 1.57；P = 0.003），60天死亡风险增加12%（校正风险比为1.12；95%置信区间为1.01 - 1.25；P = 0.04）。即使排除315名（28%）急性心肌梗死合并心力衰竭患者，入院血糖水平仍然是院内和60天死亡率的独立预测因素。入院血糖水平异常和正常的患者6个月和12个月死亡率相似。
结论：在因心力衰竭住院的非糖尿病患者中，升高的入院血糖水平与院内和60天死亡率增加相关，但与6个月或1年死亡率无关。
Background: The significance of admission blood glucose level in nondiabetic patients with heart failure ( HF) is unknown. We examined the possible association between admission glucose levels and outcome in a large cohort of hospitalized patients with HF.Methods: We analyzed the data of 4102 patients with HF, who were hospitalized during a prospective national survey. The present study focuses on a subgroup of 1122 nondiabetic patients with acute HF who were admitted because of acute HF or exacerbation of chronic HF.Results: In-hospital mortality was twice as high in patients with admission blood glucose levels in the third tertile( 7.2%) compared with the first( 3%) andsecond( 4%) tertiles( P = .02). Furthermore, mortality risk was correlated with admission glucose levels; each 18-mg/dL ( 1-mmol/L) increase in glucose level was associated with a 31% increased risk of in-hospital mortality (adjusted odds ratio, 1.31; 95% confidence interval, 1.10-1.57; P =. 003) and a 12% increase in 60-day mortality ( adjusted hazard ratio, 1.12; 95% confidence interval, 1.01-1.25; P=. 04). Admission blood glucose levels remained an independent predictor of in-hospital and 60 day mortality even after the exclusion of 315 patients(28%) with acute myocardial infarction and HF. The 6- and 12-month mortality rates were similar in patients with and without abnormal admission blood glucose levels.Conclusions: Elevated admission blood glucose levels are associated with increased in-hospital and 60-day mortality, but not 6- month or 1-year mortality, in nondiabetic patients hospitalized because of HF.