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JACC：血糖升高可预测心衰住院患者死亡率

2013-01-23 JACC CMT 高晓方 编译

心衰住院患者死亡率血糖升高
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　　法国学者的一项研究表明，急性心衰入院时血糖水平升高可显著独立预测患者30天死亡率。论文于2013年1月16日在线发表于《美国心脏病学会杂志》（J Am Coll Cardiol）。 　　此项研究从欧洲、美国和日本共纳入6212例急性心衰患者。受试者入院时中位血糖水平为7.5 mmol/L。以患者自报糖尿病、持续降糖治疗或病历中糖尿病诊断定义糖尿病。分别以血糖&g

　　法国学者的一项研究表明，急性心衰入院时血糖水平升高可显著独立预测患者30天死亡率。论文于2013年1月16日在线发表于《美国心脏病学会杂志》（J Am Coll Cardiol）。

　　此项研究从欧洲、美国和日本共纳入6212例急性心衰患者。受试者入院时中位血糖水平为7.5 mmol/L。以患者自报糖尿病、持续降糖治疗或病历中糖尿病诊断定义糖尿病。分别以血糖>7 mmol/L和>10 mmol/L定义非糖尿病患者和糖尿病患者的血糖升高。

　　结果显示，糖尿病和非糖尿病患者分别有50%和42%出现血糖升高。总体30天死亡率为10%；618例死亡者的平均血糖浓度为8.9 mmol/L，30天存活者则为7.4 mmol/L（P<0.0001）。对年龄、性别、心衰或冠心病病史、糖尿病病史、血压、心率、血钠和肾功能进行校正之后，血糖升高可显著预测30天死亡率；危险比为2.19。在各亚组患者中死亡风险升高均具有统计学意义。作为持续变量的血糖升高亦可显著预测30天死亡率。


Objective  
The aim of this analysis was to assess the association between elevated blood glucose level and mortality in acute heart failure (AHF).
Background  
Elevated blood glucose has been reported to be prognostically meaningful in patients with cardiac diagnoses, such as coronary artery disease. The short-term prognostic impact of hyperglycemia in AHF is unknown, however.
Methods  
In a multinational cohort of AHF, we examined the ability of blood glucose concentrations at presentation to predict all-cause mortality by 30 days. Fully adjusted models for prognosis included a previous diagnosis of diabetes mellitus as a covariate.
Results  
A total of 6,212 subjects with AHF (mean age, 72 years; 52.5% male) were studied; the median blood glucose concentration on arrival at the hospital was 7.5 mmol/l (135 mg/dl), and 41% had a previous diagnosis of diabetes mellitus (DM). After 30 days, 618 patients (10%) had died. Compared with survivors, decedents had significantly higher median blood glucose concentrations (8.9 mmol/l vs. 7.4 mmol/l; p < 0.0001). In the fully adjusted model, an elevated blood glucose level was an independent predictor of 30-day mortality in AHF (odds ratio: 2.19; 95% confidence interval: 1.69 to 2.83; p < 0.001). The risk associated with an elevated blood glucose level appeared consistent across all subgroups of patients, including patients with preserved (hazard ratio: 5.41; 95% confidence interval: 2.44 to 12.0; p < 0.0001) and impaired systolic function (hazard ratio: 2.37; 95% confidence interval: 1.57 to 3.59; p < 0.0001). Furthermore, in reclassification analyses, elevated blood glucose added significant prognostic information to clinical parameters alone (4.4% net reclassification improvement; p = 0.01).
Conclusions  
Among patients with AHF, blood glucose concentrations at presentation are powerfully prognostic for 30-day mortality, independent of a diagnosis of diabetes mellitus or other clinical variables. Because blood glucose is easily modifiable, it may represent a valid target for therapeutic intervention.
    

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    2014-01-07 柳叶一刀

    #血糖升高#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1976536, encodeId=5ad919e6536fd, content=<a href='/topic/show?id=82688982425' target=_blank style='color:#2F92EE;'>#血糖升高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89824, encryptionId=82688982425, topicName=血糖升高)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Tue Jan 07 15:58:00 CST 2014, time=2014-01-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2055863, encodeId=6ea0205586375, content=<a href='/topic/show?id=074651931a0' target=_blank style='color:#2F92EE;'>#心衰住院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51931, encryptionId=074651931a0, topicName=心衰住院)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=460849, createdName=ymljack, createdTime=Sun Nov 17 14:58:00 CST 2013, time=2013-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853213, encodeId=003518532137b, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Sat Oct 26 16:58:00 CST 2013, time=2013-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1983404, encodeId=cc0a1983404ec, content=<a href='/topic/show?id=628553048e3' target=_blank style='color:#2F92EE;'>#患者死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53048, encryptionId=628553048e3, topicName=患者死亡)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12de429, createdName=sunylz, createdTime=Sat Mar 02 14:58:00 CST 2013, time=2013-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1324799, encodeId=e8fd1324e99f2, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Jan 25 06:58:00 CST 2013, time=2013-01-25, status=1, ipAttribution=)]
    2013-11-17 ymljack

    #心衰住院#

    0

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    2013-10-26 hbwxf

    #JACC#

    0

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    2013-03-02 sunylz

    #患者死亡#

    0

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    2013-01-25 12498568m50暂无昵称

    #ACC#

    0

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