Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China.
Department of Ultrasound, the Second Affiliated Hospital of Nanchang University, Nanchang, China.
Front Endocrinol (Lausanne). 2024 Jul 5;15:1403452. doi: 10.3389/fendo.2024.1403452. eCollection 2024.
Diabetes is a significant risk factor for acute heart failure, associated with an increased risk of mortality. This study aims to analyze the prognostic significance of admission blood glucose (ABG) on 30-day mortality in Chinese patients with acute decompensated heart failure (ADHF), with or without diabetes.
This retrospective study included 1,462 participants from the JX-ADHF1 cohort established between January 2019 to December 2022. We conducted multivariate cox regression, restricted cubic spline, receiver operating characteristic curve analysis, and mediation analysis to explore the association and potential mechanistic pathways (inflammation, oxidative stress, and nutrition) between ABG and 30-day mortality in ADHF patients, with and without diabetes.
During the 30-day follow-up, we recorded 20 (5.36%) deaths in diabetic subjects and 33 (3.03%) in non-diabetics. Multivariate Cox regression revealed that ABG was independently associated with 30-day mortality in ADHF patients, with a stronger association in diabetics than non-diabetics (hazard ratio: Model 1: 1.71 vs 1.16; Model 2: 1.26 vs 1.19; Model 3: 1.65 vs 1.37; Model 4: 1.76 vs 1.33). Further restricted cubic spline analysis indicated a U-shaped relationship between ABG and 30-day mortality in non-diabetic ADHF patients ( for non-linearity < 0.001), with the lowest risk at ABG levels approximately between 5-7 mmol/L. Additionally, receiver operating characteristic analysis demonstrated that ABG had a higher predictive accuracy for 30-day mortality in diabetics (area under curve = 0.8751), with an optimal threshold of 13.95mmol/L. Finally, mediation analysis indicated a significant role of inflammation in ABG-related 30-day mortality in ADHF, accounting for 11.15% and 8.77% of the effect in diabetics and non-diabetics, respectively (-value of proportion mediate < 0.05).
Our study confirms that ABG is a vital indicator for assessing and predicting 30-day mortality risk in ADHF patients with diabetes. For ADHF patients, both with and without diabetes, our evidence suggests that physicians should be alert and closely monitor any changes in patient conditions when ABG exceeds 13.95 mmol/L for those with diabetes and 7.05 mmol/L for those without. Timely adjustments in therapeutic strategies, including endocrine and anti-inflammatory treatments, are advisable.
糖尿病是急性心力衰竭的重要危险因素，与死亡率增加相关。本研究旨在分析入院血糖（ABG）对伴有或不伴有糖尿病的中国急性失代偿性心力衰竭（ADHF）患者 30 天死亡率的预后意义。
本回顾性研究纳入了 2019 年 1 月至 2022 年 12 月期间 JX-ADHF1 队列中的 1462 名参与者。我们进行了多变量 Cox 回归、限制性立方样条、受试者工作特征曲线分析和中介分析，以探讨 ABG 与伴有或不伴有糖尿病的 ADHF 患者 30 天死亡率之间的关联和潜在的机制途径（炎症、氧化应激和营养）。
在 30 天随访期间，我们记录了 20 名（5.36%）糖尿病患者和 33 名（3.03%）非糖尿病患者死亡。多变量 Cox 回归显示，ABG 与 ADHF 患者的 30 天死亡率独立相关，在糖尿病患者中相关性更强（风险比：模型 1：1.71 比 1.16；模型 2：1.26 比 1.19；模型 3：1.65 比 1.37；模型 4：1.76 比 1.33）。进一步的限制性立方样条分析表明，非糖尿病 ADHF 患者的 ABG 与 30 天死亡率之间呈 U 形关系（非线性检验<0.001），ABG 水平约在 5-7mmol/L 时风险最低。此外，受试者工作特征分析表明，ABG 对糖尿病患者 30 天死亡率的预测准确性更高（曲线下面积=0.8751），最佳阈值为 13.95mmol/L。最后，中介分析表明，炎症在 ABG 相关的 ADHF 30 天死亡率中起重要作用，占糖尿病患者和非糖尿病患者效应的 11.15%和 8.77%（中介效应值的比例<0.05）。
本研究证实 ABG 是评估和预测糖尿病合并 ADHF 患者 30 天死亡率的重要指标。对于伴有或不伴有糖尿病的 ADHF 患者，我们的证据表明，当糖尿病患者的 ABG 超过 13.95mmol/L，而非糖尿病患者的 ABG 超过 7.05mmol/L 时，医生应保持警惕并密切监测患者病情的任何变化。对于这些患者，建议及时调整治疗策略，包括内分泌和抗炎治疗。
