Carrasco-Sánchez Francisco Javier, Gomez-Huelgas Ricardo, Formiga Francesc, Conde-Martel Alicia, Trullàs Joan Carles, Bettencourt Paulo, Arévalo-Lorido José Carlos, Pérez-Barquero Manuel Montero
Internal Medicine Department, Hospital Juan Ramón Jiménez, Huelva, Spain.
Internal Medicine Department, Hospital Regional Universitario, Málaga, Spain.
Diabetes Res Clin Pract. 2014 Jun;104(3):410-9. doi: 10.1016/j.diabres.2014.03.015. Epub 2014 Apr 1.
Heart failure (HF) and diabetes are common clinical conditions that may coexist. The main objective was to analyze the association of type-2 diabetes mellitus (T2DM) on prognosis in hospitalized patients with HF.
We evaluated the association between T2DM with all-cause mortality and readmissions in the Spanish National Registry on Heart Failure-"Registro Nacional de Insuficiencia Cardiaca" (RICA). This is a multi-center and prospective cohort study that includes patients admitted for decompensated HF from 2008 to 2011. Study endpoints were all-cause mortality and hospital readmission. We determined the adjusted hazard ratio (HR) by a multivariable Cox regression model.
A total of 1082 patients (mean age 77.6±8.5) were included of whom 490 (45.3%) had diabetes and 592 patients (54.7%) had preserved left ventricular ejection fraction (LVEF). During one-year follow-up, 287 patients died (151 patients with diabetes) and 383 patients were readmitted (197 patients with diabetes). After adjusting for baseline characteristics T2DM was significantly associated with all-cause mortality (HR 1.54; 95%CI 1.20-1.97, p=0.001) and readmissions (HR 1.46; 95%CI 1.18-1.80, p<0.001). Age, dementia, peripheral vascular disease, NYHA class, renal insufficiency, hyponatremia and anemia were also independently associated with outcomes. There were no differences in mortality (p=0.415) and readmissions (p=0.514) according to preserved or reduced LVEF.
T2DM is very common in patients hospitalized for HF. This condition is a strong and independent co-morbidity of all-cause mortality and readmission for both HF with preserved and reduced LVEF.
心力衰竭（HF）和糖尿病是可能并存的常见临床病症。主要目的是分析2型糖尿病（T2DM）与住院HF患者预后的关联。
我们在西班牙国家心力衰竭注册研究“Registro Nacional de Insuficiencia Cardiaca”（RICA）中评估了T2DM与全因死亡率及再入院率之间的关联。这是一项多中心前瞻性队列研究，纳入了2008年至2011年因失代偿性HF入院的患者。研究终点为全因死亡率和住院再入院率。我们通过多变量Cox回归模型确定调整后的风险比（HR）。
共纳入1082例患者（平均年龄77.6±8.5岁），其中490例（45.3%）患有糖尿病，592例（54.7%）左心室射血分数（LVEF）保留。在一年的随访期间，287例患者死亡（151例糖尿病患者），383例患者再入院（197例糖尿病患者）。在对基线特征进行调整后，T2DM与全因死亡率（HR 1.54；95%CI 1.20 - 1.97，p = 0.001）和再入院率（HR 1.46；95%CI 1.18 - 1.80，p < 0.001）显著相关。年龄、痴呆、外周血管疾病、纽约心脏协会（NYHA）分级、肾功能不全、低钠血症和贫血也与结局独立相关。根据LVEF保留或降低情况，死亡率（p = 0.415）和再入院率（p = 0.514）无差异。
T2DM在因HF住院的患者中非常常见。这种情况是全因死亡率以及LVEF保留和降低的HF患者再入院的一种强烈且独立的合并症。
