根据射血分数对急性心力衰竭患者死亡率和再住院率的影响进行分层的糖尿病。

AIMS: The aim of this study is to determine the impact of diabetes mellitus on all-cause mortality and rehospitalization rates at 3 months and at 1 year in patients admitted with acute heart failure (AHF) stratified by left ventricular ejection fraction (EF). METHODS AND RESULTS: We analysed consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012 with AHF who were enrolled in Gulf CARE, a multinational registry of patients with heart failure (HF). AHF patients were stratified into three groups: HF patients with reduced (EF) (HFrEF) (<40%), HF with mid-range EF (HFmrEF) (40-49%), and HF patients with preserved EF (HFpEF) (≥50%). Analyses were performed using univariate and multivariate statistical techniques. The mean age of the cohort was 59 ± 15 years (ranging from 18 to 99 years), and 63% (n = 2887) of the patients were males. A total of 2258 (49%) AHF patients had diabetes mellitus. The mean EF was 37 ± 14%. A reduced EF was observed in 2683 patients (59%), whereas 962 patients (21%) had mid-range and 932 patients (20%) had preserved EF. Multivariable analyses demonstrated no significant differences in all-cause mortality between diabetics and non-diabetics in all the three types of HF; at 3 months follow-up: HFrEF [adjusted odds ratio (aOR), 1.30; 95% confidence interval (CI): 0.94-1.80; P = 0.119], HFmrEF (aOR, 0.98; 95% CI: 0.51-1.87; P = 0.952), and HFpEF (aOR, 0.69; 95% CI: 0.38-1.26; P = 0.225); and at 12-months follow-up: HFrEF (aOR, 1.25; 95% CI: 0.97-1.62; P = 0.080), HFmrEF (aOR, 1.07; 95% CI: 0.68-1.68; P = 0.783), and HFpEF (aOR, 1.07; 95% CI: 0.67-1.72; P = 0.779). There were also no significant differences in rehospitalization rates between diabetics and non-diabetics in all the three types of HF; at 3 months follow-up: HFrEF (aOR, 0.94; 95% CI: 0.74-1.19; P = 0.581), HFmrEF (aOR, 0.82; 95% CI: 0.53-1.26; P = 0.369), and HFpEF (aOR, 1.06; 95% CI: 0.64-1.78; P = 0.812); and at 12-months follow-up: HFrEF (aOR, 0.93; 95% CI: 0.73-1.17; P = 0.524), HFmrEF (aOR, 0.81; 95% CI: 0.56-1.17; P = 0.257), and HFpEF (aOR, 1.29; 95% CI: 0.82-2.05; P = 0.271). CONCLUSIONS: There were no significant differences in 3 and 12 months all-cause mortality as well as rehospitalization rates between diabetics and non-diabetic patients in all the three types of AHF patients stratified by left ventricular ejection fraction.

目的：本研究旨在确定糖尿病对急性心力衰竭（AHF）患者 3 个月和 1 年全因死亡率和再住院率的影响，根据左心室射血分数（EF）分层。

方法：我们分析了 2012 年 2 月至 11 月期间来自沙特阿拉伯、阿曼、也门、科威特、阿拉伯联合酋长国、卡塔尔和巴林的 7 个中东国家的 47 家医院连续收治的 AHF 患者，并纳入了海湾心力衰竭注册研究（Gulf CARE），这是一个心力衰竭（HF）患者的多国注册研究。将 AHF 患者分为三组：射血分数降低（EF）（HFrEF）（<40%）的心力衰竭患者、射血分数中间范围（HFmrEF）（40-49%）的心力衰竭患者和射血分数保留（HFpEF）（≥50%）的心力衰竭患者。使用单变量和多变量统计技术进行分析。队列的平均年龄为 59±15 岁（年龄范围为 18-99 岁），63%（n=2887）的患者为男性。共有 2258（49%）名 AHF 患者患有糖尿病。平均 EF 为 37±14%。2683 名患者（59%）存在 EF 降低，962 名患者（21%）EF 中间范围，932 名患者（20%）EF 保留。多变量分析显示，在所有三种类型的 HF 中，糖尿病患者与非糖尿病患者的全因死亡率在 3 个月和 12 个月随访时均无显著差异；3 个月随访时：HFrEF[调整后的优势比（aOR），1.30；95%置信区间（CI）：0.94-1.80；P=0.119]、HFmrEF（aOR，0.98；95%CI：0.51-1.87；P=0.952）和 HFpEF（aOR，0.69；95%CI：0.38-1.26；P=0.225）；12 个月随访时：HFrEF（aOR，1.25；95%CI：0.97-1.62；P=0.080）、HFmrEF（aOR，1.07；95%CI：0.68-1.68；P=0.783）和 HFpEF（aOR，1.07；95%CI：0.67-1.72；P=0.779）。在所有三种类型的 HF 中，糖尿病患者与非糖尿病患者的再住院率在 3 个月和 12 个月随访时也无显著差异；3 个月随访时：HFrEF（aOR，0.94；95%CI：0.74-1.19；P=0.581）、HFmrEF（aOR，0.82；95%CI：0.53-1.26；P=0.369）和 HFpEF（aOR，1.06；95%CI：0.64-1.78；P=0.812）；12 个月随访时：HFrEF（aOR，0.93；95%CI：0.73-1.17；P=0.524）、HFmrEF（aOR，0.81；95%CI：0.56-1.17；P=0.257）和 HFpEF（aOR，1.29；95%CI：0.82-2.05；P=0.271）。

结论：在根据左心室射血分数分层的所有三种类型的 AHF 患者中，3 个月和 12 个月时的全因死亡率和再住院率在糖尿病患者和非糖尿病患者之间无显著差异。

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新学期，新优惠

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Impact of diabetes on mortality and rehospitalization in acute heart failure patients stratified by ejection fraction.

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