Liu Dan, Liu Li, Li Nan, Zhou Yiling, Huang Hongmei, He Jidong, Yao Heling, Chen Xiangyang, Tang Xiaochi, Wang Miye, Qi Ying, Wang Si, Zhu Ye, Tian Haoming, An Zhenmei, Li Sheyu
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Sichuan, China.
Department of Endocrinology and Metabolism, Second People's Hospital of Ya'an City, Sichuan, China.
Arch Med Sci. 2024 Oct 22;20(5):1416-1425. doi: 10.5114/aoms/184153. eCollection 2024.
We aimed to explore the prognostic value of the aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio in non-surgical patients with type 2 diabetes hospitalized for heart failure.
Using a large electronic medical record-based cohort of diabetes in China (WECODe), we gathered data on non-surgical hospitalized patients with type 2 diabetes and heart failure from 2011 to 2019. Baseline AST/ALT ratio was calculated. The primary outcomes were all-cause death within 30 days after discharge, composite cardiac events, major acute kidney injury, and major systemic infection. A multivariable Cox proportional regression model was utilized to evaluate the association between the AST/ALT ratio and outcomes.
This retrospective cohort included 8,073 patients (39.4% women) with type 2 diabetes hospitalized for heart failure. The median age was 71 years. Higher AST/ALT ratio was associated with higher risks of poor endpoints (with per standard deviation increment in AST/ALT ratio, for death within 30 days after discharge: adjusted hazard ratio [HR] = 1.35, 95% confidence interval [CI], 1.21 to 1.50; for composite cardiac events: HR = 1.18, 95% CI: 1.06 to 1.31). Compared to patients in the lowest quartile for the AST/ALT ratio, those in the highest quartile have elevated risk of death within 30 days after discharge and major systemic infection (HRs [95% CIs] 1.61 [1.18 to 2.19] and 1.28 [1.06 to 1.56], respectively). Subgroup analyses and sensitivity analyses confirmed the robustness of the findings.
Type 2 diabetes patients hospitalized for heart failure with the AST/ALT ratio in the highest quartile face a poor short-term prognosis.
我们旨在探讨天冬氨酸氨基转移酶与丙氨酸氨基转移酶比值（AST/ALT）在因心力衰竭住院的非手术2型糖尿病患者中的预后价值。
利用中国一个基于大型电子病历的糖尿病队列（WECODe），我们收集了2011年至2019年因心力衰竭住院的非手术2型糖尿病患者的数据。计算基线AST/ALT比值。主要结局为出院后30天内全因死亡、复合心脏事件、严重急性肾损伤和严重全身感染。采用多变量Cox比例回归模型评估AST/ALT比值与结局之间的关联。
该回顾性队列包括8073例因心力衰竭住院的2型糖尿病患者（39.4%为女性）。中位年龄为71岁。较高的AST/ALT比值与不良结局风险较高相关（AST/ALT比值每增加一个标准差，出院后30天内死亡：调整后风险比[HR]=1.35，95%置信区间[CI]，1.21至1.50；复合心脏事件：HR=1.18，95%CI：1.06至1.31）。与AST/ALT比值处于最低四分位数的患者相比，处于最高四分位数的患者出院后30天内死亡和严重全身感染的风险升高（HRs[95%CI]分别为1.61[1.18至2.19]和1.28[1.06至1.56]）。亚组分析和敏感性分析证实了研究结果的稳健性。
因心力衰竭住院且AST/ALT比值处于最高四分位数的2型糖尿病患者短期预后较差。
