Department of Cardiology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
J Diabetes Complications. 2024 Dec;38(12):108895. doi: 10.1016/j.jdiacomp.2024.108895. Epub 2024 Oct 22.
Stress hyperglycemia is prevalent in critical illnesses and has been associated with adverse short- and long-term outcomes in individuals with acute coronary syndrome (ACS). However, there is limited evidence for the predictive value of stress hyperglycemia and hospitalization mortality in patients with chronic kidney disease (CKD) and ACS. This study aimed to explore the association between hospitalized mortality, stress hyperglycemia ratio (SHR), and admission blood glucose (ABG) in patients with CKD and ACS.
This study included 655 hospitalized patients who were diagnosed with ACS and CKD. Patients with incomplete data were excluded, resulting in the analysis of 550 patients. The primary outcome measured was in-hospital mortality.
The median age of the cohort included in the analysis was 71 years, with a male proportion of 66.2 %, and a mean estimated glomerular filtration rate (eGFR) of 27.8 mL/min/1.73 m. Patients classified as having stage 3, stage 4, and stage 5 chronic kidney disease (CKD) comprised 46.9 %, 17.1 %, and 36.0 % of the population, respectively. The overall in-hospital mortality rate was 10.7 % (n = 59). Both SHR (OR = 2.67; 95 % CI 1.51-4.74; p < 0.001) and ABG (OR = 1.09; 95 % CI 1.04-1.14; p < 0.001) were significantly associated with in-hospital mortality in CKD and ACS patients. SHR and ABG showed a linear relationship with in-hospital mortality, with SHR demonstrating superior reclassification ability over ABG. The inclusion of SHR or ABG, irrespective of diabetes mellitus status, substantially enhanced the predictive performance of the Global Registry of Acute Coronary Events (GRACE) score model.
In patients with ACS and CKD, a robust correlation was observed between SHR, ABG, and in-hospital mortality. Both SHR and ABG improved the predictive accuracy of the GRACE score in forecasting inpatient mortality in this population.
应激性高血糖在危重病中很常见，并且与急性冠状动脉综合征（ACS）患者的短期和长期不良结局相关。然而，应激性高血糖对慢性肾脏病（CKD）和 ACS 患者的预测价值以及住院死亡率的证据有限。本研究旨在探讨 CKD 和 ACS 患者住院死亡率、应激性高血糖比值（SHR）和入院血糖（ABG）之间的关系。
本研究纳入了 655 名诊断为 ACS 和 CKD 的住院患者。排除了数据不完整的患者，最终对 550 名患者进行了分析。主要结局指标为住院死亡率。
纳入分析的队列的中位年龄为 71 岁，男性比例为 66.2%，平均估算肾小球滤过率（eGFR）为 27.8 mL/min/1.73 m。患者中，CKD 分期 3 期、4 期和 5 期的比例分别为 46.9%、17.1%和 36.0%。总的住院死亡率为 10.7%（n=59）。SHR（OR=2.67；95%CI 1.51-4.74；p<0.001）和 ABG（OR=1.09；95%CI 1.04-1.14；p<0.001）均与 CKD 和 ACS 患者的住院死亡率显著相关。SHR 和 ABG 与住院死亡率呈线性关系，SHR 较 ABG 具有更好的重新分类能力。无论糖尿病状态如何，纳入 SHR 或 ABG 均可显著提高全球急性冠状动脉事件注册（GRACE）评分模型的预测性能。
在 ACS 和 CKD 患者中，SHR、ABG 和住院死亡率之间存在很强的相关性。SHR 和 ABG 均提高了该人群预测住院死亡率的 GRACE 评分的准确性。
