Department of Traditional Chinese Medicine, Xuhui District Central Hospital, Shanghai, P.R. China.
Department of Traditional Chinese Medicine, Jiangpu Community Health Service Center, Shanghai, P.R. China.
PLoS One. 2024 Sep 13;19(9):e0307905. doi: 10.1371/journal.pone.0307905. eCollection 2024.
Although blood glucose changes have been suggested to be a potential better target for clinical control than baseline blood glucose levels, the association of blood glucose changes with the prognosis in acute myocardial infarction (AMI) patients with diabetes mellitus (DM) is unclear. Herein, this study aimed to investigate association of short-term longitudinal trajectory of blood glucose with 30-day mortality in this population.
Data of AMI patients with DM were extracted from the Medical Information Mart for Intensive Care (MIMIC) database in 2003-2019 in this retrospective cohort study. The latent growth mixture modeling (LGMM) model was utilized to classify the 24-hour longitudinal trajectory of blood glucose of the patients. Kaplan-Meier (KM) curve was drawn to show 30-day mortality risk in patients with different trajectory classes. Univariate and multivariate Cox regression analyses were employed to explore the association of longitudinal trajectory of blood glucose within 24 hours after the ICU admission with 30-day mortality. Also, subgroups analysis of age, gender, and AMI types was performed. The evaluation indexes were hazard ratios (HRs) and 95% confidence intervals (CIs).
Among 1,523 eligible patients, 227 (14.9%) died within 30 days. We identified 4 longitudinal trajectories of blood glucose, including class 1 (a low initial average blood glucose level with steady trend within 24 hours), class 2 (a high initial average blood glucose with gently decreased trend), class 3 (the highest initial average blood glucose with rapidly decreased trend) and class 4 (a high initial average blood glucose level with the trend that increased at first and then decreased). After adjusting for covariates, an average blood glucose level of ≥200 mg/dL was linked to higher risk of 30-day mortality, comparing to that of <140 mg/dL (HR = 1.80, 95%CI: 1.23-2.63). Comparing to patients whose longitudinal trajectory of blood glucose conformed to class 1, those with class 2 (HR = 2.52, 95%CI: 1.79-3.53) or class 4 (HR = 3.53, 95%CI: 2.07-6.03) seemed to have higher risk of 30-day mortality. Additionally, these associations were also significant in aged ≥60 years old, female, male, NSTEMI, and STEMI subgroups (all P<0.05).
A low level of average blood glucose at the ICU admission or reducing blood glucose to a normal level quickly with adequate measures in 24 hours after ICU admission may be beneficial for AMI patients with DM to reduce the risk of 30-day mortality. These findings may provide some information for further exploration on appropriate range of blood glucose changes in clinical practice.
虽然血糖变化被认为是比基线血糖水平更能作为临床控制的潜在更好目标，但血糖变化与糖尿病合并急性心肌梗死（AMI）患者预后之间的关系尚不清楚。在此，本研究旨在探讨该人群中血糖短期纵向变化轨迹与 30 天死亡率之间的关联。
本回顾性队列研究从 2003 年至 2019 年的医疗信息重症监护室（MIMIC）数据库中提取了糖尿病合并 AMI 患者的数据。采用潜增长混合模型（LGMM）模型对患者 24 小时的血糖纵向变化轨迹进行分类。绘制 Kaplan-Meier（KM）曲线以显示不同轨迹类别的 30 天死亡率风险。采用单变量和多变量 Cox 回归分析探讨 ICU 入院后 24 小时内血糖纵向变化轨迹与 30 天死亡率之间的关系。还对年龄、性别和 AMI 类型进行了亚组分析。评估指标为危险比（HRs）和 95%置信区间（CIs）。
在 1523 名合格患者中，有 227 名（14.9%）在 30 天内死亡。我们确定了 4 种血糖纵向变化轨迹，包括轨迹 1（初始平均血糖水平较低，24 小时内呈稳定趋势）、轨迹 2（初始平均血糖水平较高，呈缓慢下降趋势）、轨迹 3（初始平均血糖水平最高，呈快速下降趋势）和轨迹 4（初始平均血糖水平较高，呈先升高后降低的趋势）。在校正了混杂因素后，平均血糖水平≥200mg/dL 与 30 天死亡率风险增加相关，与<140mg/dL 相比（HR=1.80，95%CI：1.23-2.63）。与血糖纵向变化轨迹符合轨迹 1 的患者相比，轨迹 2（HR=2.52，95%CI：1.79-3.53）或轨迹 4（HR=3.53，95%CI：2.07-6.03）的患者似乎有更高的 30 天死亡率风险。此外，这些关联在年龄≥60 岁、女性、男性、非 ST 段抬高型心肌梗死（NSTEMI）和 ST 段抬高型心肌梗死（STEMI）亚组中也具有统计学意义（均 P<0.05）。
在 ICU 入院时血糖水平较低或在 ICU 入院后 24 小时内通过适当措施迅速将血糖降至正常水平可能有利于降低糖尿病合并 AMI 患者 30 天死亡率的风险。这些发现可能为进一步探索临床实践中血糖变化的适当范围提供一些信息。
