首次诊断为急性心肌梗死患者的应激性高血糖比值与90天和180天死亡率之间的J形关系：MIMIC-IV数据库分析
J-shaped relationship between stress hyperglycemia ratio and 90-day and 180-day mortality in patients with a first diagnosis of acute myocardial infarction: analysis of the MIMIC-IV database.
作者信息
Hu Ben, Chen Xinghua, Wang Yuhui, Wei Xing, Feng Jun, Hou Linlin
机构信息
Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China.
The Fifth Clinical Medical School of Anhui Medical University, Hefei, 230000, Anhui, China.
出版信息
Diabetol Metab Syndr. 2024 Jun 16;16(1):132. doi: 10.1186/s13098-024-01380-2.
AIMS
The Stress Hyperglycemia Ratio (SHR) potently predicts adverse outcomes in patients with cardiovascular and cerebrovascular diseases. However, the relationship between SHR and short-term mortality risk in patients with a first diagnosis of acute myocardial infarction (AMI) remains contentious. This study sought to understand better the relationship between SHR and short-term mortality risk in patients with a first diagnosis of AMI.
METHODS
We conducted a cohort study using data from 1961 patients with a first diagnosis of AMI from the MIMIC-IV (version 2.2) database. Patients were divided into three groups based on SHR tertiles. The Cox proportional hazards model and a two-segmented Cox proportional hazards model were used to elucidate the nonlinear relationship between SHR in patients with a first diagnosis of AMI and mortality.
RESULTS
Of the surveyed population, 175 patients (8.92%) died within 90 days, and 210 patients (10.71%) died within 180 days. After multivariate adjustments, elevated SHR levels were significantly and non-linearly associated with a higher risk of 90-day and 180-day mortality in patients with a first diagnosis of AMI, showing a J-shaped correlation with an inflection point at 0.9. Compared to participants with SHR levels below the inflection point, those with higher SHR levels had a fivefold increased risk of 90-day mortality (hazard ratio [HR] 5.74; 95% confidence interval [CI] 3.19, 10.33) and a fourfold increased risk of 180-day mortality (HR 4.56; 95% CI 2.62, 7.95). In the subgroup analysis, patients with pre-diabetes mellitus (pre-DM) and higher SHR levels had increased 90-day (HR 6.90; 95% CI 1.98, 24.02) and 180-day mortality risks (HR 5.30; 95% CI 1.96, 14.27).
CONCLUSION
In patients with a first diagnosis of AMI, there is a J-shaped correlation between SHR and 90-day and 180-day mortality, with an adverse prognostic inflection point of SHR at 0.9.
目的
应激性高血糖比值（SHR）能有效预测心血管和脑血管疾病患者的不良预后。然而，首次诊断为急性心肌梗死（AMI）患者的SHR与短期死亡风险之间的关系仍存在争议。本研究旨在更好地了解首次诊断为AMI患者的SHR与短期死亡风险之间的关系。
方法
我们使用MIMIC-IV（版本2.2）数据库中1961例首次诊断为AMI患者的数据进行了一项队列研究。根据SHR三分位数将患者分为三组。采用Cox比例风险模型和两段式Cox比例风险模型来阐明首次诊断为AMI患者的SHR与死亡率之间的非线性关系。
结果
在被调查人群中，175例患者（8.92%）在90天内死亡，210例患者（10.71%）在180天内死亡。经过多变量调整后，首次诊断为AMI患者的SHR水平升高与90天和180天死亡风险显著且呈非线性相关，呈现出J形相关性，拐点为0.9。与SHR水平低于拐点的参与者相比，SHR水平较高的参与者90天死亡风险增加了五倍（风险比[HR] 5.74；95%置信区间[CI] 3.19，10.33），180天死亡风险增加了四倍（HR 4.56；95% CI 2.62，7.95）。在亚组分析中，患有糖尿病前期（pre-DM）且SHR水平较高的患者90天（HR 6.90；95% CI 1.98，24.02）和180天死亡风险增加（HR 5.30；95% CI 1.96，14.27）。
结论
在首次诊断为AMI的患者中，SHR与90天和180天死亡率之间存在J形相关性，SHR的不良预后拐点为0.9。
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