Intensive Cardiac Coronary Unit Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Intern Emerg Med. 2012 Dec;7(6):497-503. doi: 10.1007/s11739-011-0597-4. Epub 2011 May 5.
No data is so far available on the relation between glucose values and insulin resistance and mortality, both at short- and long-term, in patients with acute heart failure syndromes (AHF). We prospectively assessed in 100 consecutive non-diabetic AHF patients whether acute glucose metabolism, as indicated by fasting glycemia and insulin resistance (HOMA index) was able to affect short- and long-term mortality. In the overall population, 51 patients showed admission glucose values >140 mg/dl. No significant difference was observed in admission and peak glycemia, insulin and C-peptide values and in HOMA-index between dead and survived patients. At multivariate logistic backward stepwise analysis the following variables were independent predictors for in-ICCU mortality (when adjusted for left ventricular ejection fraction): Fibrinogen (1 mg/dl increase) [OR (95% CI) 0.991 (0.984-0.997); p = 0.004]; NT-pro BNP (100 UI increase) [OR (95%CI) 1.005 (1.002-1.009); p = 0.004]; leukocyte count (1,000/μl increase) [OR (95%CI) 1.252 (1.070-1.464); p = 0.005]. eGFR was independently correlated with long-term mortality (HR 0.96, 95%CI 0.94-0.98, p < 0.001). In consecutive patients with acute heart failure without previously known diabetes, we documented, for the first time, that fasting glucose and insulin values and insulin resistance do not affect mortality at short- and long-term. Inflammatory activation (as indicated by the leukocyte count and the fibrinogen) and NT-pro BNP levels are independent predictors for early death while the eGFR affects the long-term mortality.
目前尚无关于急性心力衰竭综合征（AHF）患者短期和长期血糖值与胰岛素抵抗和死亡率之间关系的数据。我们前瞻性评估了 100 例连续的非糖尿病 AHF 患者，急性血糖代谢（如空腹血糖和胰岛素抵抗（HOMA 指数））是否能够影响短期和长期死亡率。在总体人群中，51 例患者的入院血糖值>140mg/dl。死亡和存活患者的入院和峰值血糖、胰岛素和 C 肽值以及 HOMA 指数无显著差异。多变量逻辑后退逐步分析表明，以下变量是 ICU 内死亡率的独立预测因素（当调整左心室射血分数时）：纤维蛋白原（增加 1mg/dl）[OR（95%CI）0.991（0.984-0.997）；p=0.004]；NT-proBNP（增加 100UI）[OR（95%CI）1.005（1.002-1.009）；p=0.004]；白细胞计数（增加 1000/μl）[OR（95%CI）1.252（1.070-1.464）；p=0.005]。eGFR 与长期死亡率独立相关（HR 0.96，95%CI 0.94-0.98，p<0.001）。在连续的急性心力衰竭患者中，我们首次记录到空腹血糖和胰岛素值以及胰岛素抵抗不会影响短期和长期死亡率。炎症激活（如白细胞计数和纤维蛋白原）和 NT-proBNP 水平是早期死亡的独立预测因素，而 eGFR 影响长期死亡率。
