Chen Yu, Wang YingZhi, Chen Fang, Chen CaiHua, Dong XinJiang
Department of Cardiac Surgery, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, 317000 Linhai, Zhejiang, China.
Department of Cardiology, Shanxi Cardiovascular Hospital, 030024 Taiyuan, Shanxi, China.
Rev Cardiovasc Med. 2024 Aug 5;25(8):275. doi: 10.31083/j.rcm2508275. eCollection 2024 Aug.
Heart failure (HF) is a primary public health issue associated with a high mortality rate. However, effective treatments still need to be developed. The optimal level of glycemic control in non-diabetic critically ill patients suffering from HF is uncertain. Therefore, this study examined the relationship between initial glucose levels and in-hospital mortality in critically ill non-diabetic patients with HF.
A total of 1159 critically ill patients with HF were selected from the Medical Information Mart for Intensive Care-III (MIMIC-III) data resource and included in this study. The association between initial glucose levels and hospital mortality in seriously ill non-diabetic patients with HF was analyzed using smooth curve fittings and multivariable Cox regression. Stratified analyses were performed for age, gender, hypertension, atrial fibrillation, CHD with no MI (coronary heart disease with no myocardial infarction), renal failure, chronic obstructive pulmonary disease (COPD), estimated glomerular filtration rate (eGFR), and blood glucose concentrations.
The hospital mortality was identified as 14.9%. A multivariate Cox regression model, along with smooth curve fitting data, showed that the initial blood glucose demonstrated a U-shape relationship with hospitalized deaths in non-diabetic critically ill patients with HF. The turning point on the left side of the inflection point was HR 0.69, 95% CI 0.47-1.02, = 0.068, and on the right side, HR 1.24, 95% CI 1.07-1.43, = 0.003. Significant interactions existed for blood glucose concentrations (7-11 mmol/L) (-value for interaction: 0.009). No other significant interactions were detected.
This study demonstrated a U-shape correlation between initial blood glucose and hospital mortality in critically ill non-diabetic patients with HF. The optimal level of initial blood glucose for non-diabetic critically ill patients with HF was around 7 mmol/L.
心力衰竭（HF）是一个与高死亡率相关的主要公共卫生问题。然而，仍需要开发有效的治疗方法。非糖尿病重症心力衰竭患者的最佳血糖控制水平尚不确定。因此，本研究探讨了重症非糖尿病心力衰竭患者初始血糖水平与住院死亡率之间的关系。
从重症监护医学信息数据库三期（MIMIC-III）数据资源中选取1159例重症心力衰竭患者纳入本研究。采用平滑曲线拟合和多变量Cox回归分析重症非糖尿病心力衰竭患者初始血糖水平与医院死亡率之间的关联。对年龄、性别、高血压、心房颤动、无心肌梗死的冠心病（CHD）、肾衰竭、慢性阻塞性肺疾病（COPD）、估计肾小球滤过率（eGFR）和血糖浓度进行分层分析。
医院死亡率为14.9%。多变量Cox回归模型和平滑曲线拟合数据显示，初始血糖与非糖尿病重症心力衰竭患者的住院死亡呈U形关系。拐点左侧的转折点HR为0.69，95%CI为0.47-1.02，P = 0.068，右侧HR为1.24，95%CI为1.07-1.43，P = 0.003。血糖浓度（7-11 mmol/L）存在显著交互作用（交互作用P值：0.009）。未检测到其他显著交互作用。
本研究表明，重症非糖尿病心力衰竭患者初始血糖与医院死亡率呈U形相关。非糖尿病重症心力衰竭患者的最佳初始血糖水平约为7 mmol/L。
