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. 2018 Sep 5;131(17):2032-2040.
doi: 10.4103/0366-6999.239310.

Prognostic Impact of Fasting Plasma Glucose on Mortality and Re-Hospitalization in Patients With Acute Heart Failure

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Free PMC article

Prognostic Impact of Fasting Plasma Glucose on Mortality and Re-Hospitalization in Patients With Acute Heart Failure

Yu-Yang Chen et al. Chin Med J (Engl). .
Free PMC article

Abstract

Background: The impact of fasting plasma glucose (FPG) on survival outcomes in patients with acute heart failure (HF) is unclear, and the relationship between intensity of glycemic control of FPG in diabetes mellitus (DM) patients and HF prognosis remains uncertain. This retrospective study aimed to evaluate the prognostic impact of FPG in patients with acute HF.

Methods: A total of 624 patients hospitalized with acute HF from October 2000 to April 2014 were enrolled in this study. All patients were stratified by three groups according to their admission FPG levels (i.e., DM, impaired fasting glucose [IFG], and non-DM). All-cause and cardiovascular mortality was the primary end point, and HF re-hospitalization was the secondary end point during follow-up period.

Results: A total of 587 patients were included in final analysis. The all-cause mortality rates of patients with DM, IFG, and non-DM were 55.5%, 40.3%, and 39.2%, with significant difference (P = 0.001). Moreover, compared with those with IFG (34.3%) and non-DM (32.6%), patients with DM had significantly higher rate of cardiovascular mortality (45.1%). Multiple Cox regression analysis showed that DM as well as IFG was related to all-cause mortality (DM: hazard ratio [HR] = 1.936, P < 0.001; IFG: HR = 1.672, P = 0.019) and cardiovascular mortality (DM: HR = 1.739, P < 0.001; IFG: HR = 1.817, P = 0.013). However, they were both unrelated to HF re-hospitalization. DM patients with strictly controlled blood glucose (FPG <3.9 mmol/L) had higher all-cause mortality than patients with non-DM, IFG, and DM patients with moderately controlled glucose (3.9 mmol/L≤ FPG <7.0 mmol/L). Likewise, both the primary end point and secondary end point were found to be worse in DM patients with poorly controlled blood glucose (FPG ≥7.0 mmol/L).

Conclusions: IFG and DM were associated with higher all-cause mortality and cardiovascular mortality in patients with acute HF. The association between mortality and admission FPG in DM patients with acute HF appeared U-shaped.

空腹血糖水平对急性心力衰竭患者生存率及心衰再住院率的影响摘要背景:空腹血糖(FPG)对急性心力衰竭患者预后的影响至今尚未明确,糖尿病(DM)患者空腹血糖的控制程度与急性心力衰竭预后的关系也不明朗。本回顾性研究旨在评估FPG水平对急性心力衰竭患者预后的影响。 方法:本研究收集了从2000年10月至2014年4月624例急性心衰住院患者。所有患者按入院FPG水平分为三组(DM组、空腹血糖受损[IFG]组和non-DM组)。我们定义全因死亡率和心血管疾病死亡率为主要终点事件,心衰恶化再住院率为次要终点事件,所有患者出院后进行随访直至终点事件发生。 结果:587患者被纳入最终分析。 DM、IFG和非DM患者的全因死亡率分别为55.5%,40.3%和39.2%,有统计学差异(P = 0.001)。此外,与IFG患者(34.3%)和非DM患者(32.6%)相比,DM患者的心血管死亡率明显更高(45.1%)。多重Cox回归分析显示DM和IFG与全因死亡率(DM:HR = 1.936,P <0.001; IFG:HR = 1.672,P = 0.019)和心血管死亡率(DM:HR = 1.739,P <0.001; IFG:HR = 1.817,P = 0.013)相关。 然而,他们均与心衰再住院无关。 与非DM患者、IFG患者和FPG控制中等的DM患者(3.9 mmol/L ≤ FPG<7.0 mmol/L )相比,FPG控制严格的DM患者(FPG<3.9 mmol/L)的全因死亡率更高。同样,FPG控制不佳(FPG ≥7.0 mmol/L)的DM患者与非DM患者、IFG患者和FPG控制中等的DM患者相比有更高的主要终点事件和次要终点事件发生率。 结论IFG和糖尿病可能会增加急性心衰患者的全因死亡率和心血管疾病死亡率。糖尿病合并急性心衰的患者,其死亡率与入院FPG水平呈U形曲线。.

Keywords: Diabetes Mellitus; Heart Failure; Hyperglycemia; Prognosis.

Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1
Figure 1
Cumulative incidence rates of all-cause mortality, cardiovascular mortality, and HF re-hospitalization in patients with acute HF. IFG: Impaired fasting glucose; DM: Diabetes mellitus; HF: Heart failure.
Figure 2
Figure 2
Kaplan–Meier curves for overall survival rate (a and b), free survival rates of cardiovascular event (c and d), and HF re-hospitalization event (e and f) among different groups of acute HF patients, who were stratified by FPG levels. Non-DM, IFG, and DM groups corresponded to groups G1, G2, and G3 in Figure 2a, 2c and 2e; DM groups were further subdivided into three subgroups according to controlled FPG levels: FPG <3.9 mmol/L, 3.9 mmol/L≤ FPG <7.0 mmol/L and FPG ≥7.0 mmol/L corresponding to groups g3, g4 and g5; non-DM and IFG groups corresponded to groups g1 and g2 in Figure 2b, 2d and 2f. IFG: Impaired fasting glucose; DM: Diabetes mellitus; HF: Heart failure.

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