应激性高血糖比值对急性心肌炎患者院内及长期不良预后的影响

Impact of the Stress Hyperglycemia Ratio on In-Hospital and Long-Term Poor Prognosis in Patients with Acute Myocarditis.

作者信息

Zhao Yan, Yang Jie, Chen Jing, Yang Xu, Zhang Wei, Lv Naqiang, Tan Huiqiong, Tang Yi-Da

机构信息

State Key Laboratory of Cardiovascular Disease, Department of Special Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China.

Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China.

出版信息

Rev Cardiovasc Med. 2023 Apr 4;24(4):103. doi: 10.31083/j.rcm2404103. eCollection 2023 Apr.

DOI:10.31083/j.rcm2404103

PMID:39076259

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11273025/

Abstract

BACKGROUND

Few studies have focused on the impact of stress hyperglycemia on adverse outcomes in patients with acute myocarditis. We conducted the present study to assess the association between the stress hyperglycemia ratio (SHR) and poor prognosis in patients with acute myocarditis.

METHODS

From 2006 to 2020, 185 patients with acute myocarditis were enrolled. The SHR was defined as glucose at admission divided by estimated average glucose ([(1.59 HbA1c %) - 2.59], glycated hemoglobin [HbA1c]). Participants were divided into two groups according to their SHR values. The primary endpoint was defined as in-hospital major adverse cardiovascular events (MACE), including death, heart transplantation, the need for mechanical circulatory support (MCS), and transfer to the intensive care unit (ICU). The secondary endpoint was defined as long-term MACE.

RESULTS

Subjects in the higher SHR group had more serious conditions, including lower systolic blood pressure, higher heart rate, higher white blood cell count, higher levels of alanine transaminase, troponin I, and C-reactive protein, and worse cardiac function. Multivariate logistic analysis showed that SHR 1.12 (hazard ratio (HR): 3.946, 95% confidence interval (CI): 1.098-14.182; = 0.035) was independently associated with in-hospital MACE in patients with acute myocarditis. Kaplan-Meier survival analysis and multivariate Cox analysis suggested that an SHR 1.39 (HR: 1.931, 95% CI: 0.323-2.682; = 0.895) was not significantly associated with long-term prognosis.

CONCLUSIONS

SHR was independently associated with in-hospital adverse outcomes in patients with acute myocarditis but not with long-term prognosis.

摘要

背景

很少有研究关注应激性高血糖对急性心肌炎患者不良结局的影响。我们开展本研究以评估应激性高血糖比率（SHR）与急性心肌炎患者预后不良之间的关联。

方法

2006年至2020年，纳入185例急性心肌炎患者。SHR定义为入院时血糖除以估算平均血糖（[(1.59×糖化血红蛋白[HbA1c%]) - 2.59]）。根据SHR值将参与者分为两组。主要终点定义为住院期间主要不良心血管事件（MACE），包括死亡、心脏移植、需要机械循环支持（MCS）以及转入重症监护病房（ICU）。次要终点定义为长期MACE。

结果

SHR较高组的受试者病情更严重，包括收缩压较低、心率较高、白细胞计数较高、丙氨酸转氨酶、肌钙蛋白I和C反应蛋白水平较高，以及心功能较差。多因素逻辑回归分析显示，SHR≥1.12（风险比（HR）：3.946，95%置信区间（CI）：1.098 - 14.182；P = 0.035）与急性心肌炎患者住院期间的MACE独立相关。Kaplan-Meier生存分析和多因素Cox分析表明，SHR≥1.39（HR：1.931，95%CI：0.323 - 2.682；P = 0.895）与长期预后无显著关联。