Centro Cardiologico Monzino IRCCS, Milan, Italy
Centro Cardiologico Monzino IRCCS, Milan, Italy.
J Am Heart Assoc. 2018 Apr 13;7(8):e008122. doi: 10.1161/JAHA.117.008122.
In acute myocardial infarction, acute hyperglycemia is a predictor of acute kidney injury (AKI), particularly in patients without diabetes mellitus. This emphasizes the importance of an acute glycemic rise rather than glycemia level at admission. We investigated whether, in diabetic patients with acute myocardial infarction, the combined evaluation of acute and chronic glycemic levels may have better prognostic value for AKI than admission glycemia.
At admission, we prospectively measured glycemia and estimated average chronic glucose levels (mg/dL) using glycosylated hemoglobin (HbA), according to the following formula: 28.7×HbA (%)-46.7. We evaluated the association with AKI of the acute/chronic glycemic ratio and of the difference between acute and chronic glycemia (Δ). We enrolled 474 diabetic patients with acute myocardial infarction. Of them, 77 (16%) experienced AKI. The incidence of AKI increased in parallel with the acute/chronic glycemic ratio (12%, 14%, 22%; =0.02 for trend) and Δ (13%, 13%, 23%; =0.01) but not with admission glycemic tertiles (=0.22). At receiver operating characteristic analysis, the acute/chronic glycemic ratio (area under the curve: 0.62 [95% confidence interval, 0.55-0.69]; =0.001) and Δ (area under the curve: 0.62 [95% confidence interval, 0.54-0.69]; =0.002) accurately predicted AKI, without difference in the area under the curve between them (=0.53). At reclassification analysis, the addition of the acute/chronic glycemic ratio and Δ to acute glycemia allowed proper AKI risk prediction in 16% of patients.
In diabetic patients with acute myocardial infarction, AKI is better predicted by the combined evaluation of acute and chronic glycemic values than by assessment of admission glycemia alone.
在急性心肌梗死中，急性高血糖是急性肾损伤（AKI）的预测因素，尤其是在无糖尿病的患者中。这强调了急性血糖升高而不是入院时的血糖水平的重要性。我们研究了在急性心肌梗死合并糖尿病的患者中，急性和慢性血糖水平的联合评估是否比入院血糖对 AKI 的预后价值更好。
入院时，我们前瞻性地测量了血糖，并根据糖化血红蛋白（HbA）计算了平均慢性血糖水平（mg/dL），公式为：28.7×HbA（%）-46.7。我们评估了急性/慢性血糖比值和急性与慢性血糖差值（Δ）与 AKI 的关系。我们纳入了 474 例急性心肌梗死合并糖尿病的患者。其中 77 例（16%）发生 AKI。AKI 的发生率与急性/慢性血糖比值呈平行增加（12%、14%、22%；=0.02 趋势）和 Δ（13%、13%、23%；=0.01），但与入院血糖三分位数无关（=0.22）。在接收者操作特征分析中，急性/慢性血糖比值（曲线下面积：0.62 [95%置信区间，0.55-0.69]；=0.001）和 Δ（曲线下面积：0.62 [95%置信区间，0.54-0.69]；=0.002）准确预测 AKI，曲线下面积之间无差异（=0.53）。在重新分类分析中，将急性/慢性血糖比值和 Δ 添加到急性血糖中，可使 16%的患者适当预测 AKI 风险。
在急性心肌梗死合并糖尿病的患者中，急性和慢性血糖值的联合评估比单独评估入院血糖更能预测 AKI。
