Menon Lakshmi, Pawar Shubhadarshini, Regalla Dileep Kumar Reddy
Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Department of Interventional Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA.
J Clin Med. 2025 Mar 28;14(7):2308. doi: 10.3390/jcm14072308.
Diabetes insipidus affects heart failure outcomes through its impact on volume status and electrolyte imbalance. However, previous data on its impact on heart failure hospitalizations are limited. This study aimed to evaluate the prognostic implications of diabetes insipidus in patients admitted with heart failure. We utilized the United States National Readmissions Database (NRD) from the years 2016 to 2021. Adult patients hospitalized with a primary diagnosis of heart failure were stratified based on the presence of diabetes insipidus. Propensity matching was used to balance the baseline characteristics. Multivariable logistic regression was used to estimate the association of heart failure with diabetes insipidus on clinical outcomes, complications, 30-day readmissions, and healthcare utilization. Among 5,946,749 heart failure hospitalizations, 2846 (0.04%) had a secondary diagnosis of diabetes insipidus. Compared with matched control, patients with heart failure and diabetes insipidus had significantly higher in-hospital mortality (odds ratio [OR] 5.77 [95% CI, 4.78-6.97], < 0.001). Patients with heart failure and diabetes insipidus were also associated with increased odds of acute kidney injury (OR 2.11 [95% CI, 1.86-2.39], < 0.001), hypernatremia (OR 4.98 [95% CI, 1.86-2.39], < 0.001), cardiogenic shock (OR 1.69 [95% CI, 1.32-2.15], < 0.001), and cerebral edema (OR 22.28 [95% CI, 14.74-33.69], < 0.001) compared with the matched controls. No difference was found in the all-cause readmission (OR 0.89 [95% CI, 0.76-1.04], = 0.14), but patients with diabetes insipidus had a lower risk of heart failure readmissions (OR 0.47 [95% CI, 0.33-0.66], < 0.001) and a higher risk of non-cardiac readmissions (OR 2.21 [95% CI, 1.48-3.9], < 0.001). Diabetes insipidus was associated with worse outcomes in patients with primary heart failure hospitalizations, which was likely secondary to the risk of excessive diuresis.
尿崩症通过对容量状态和电解质失衡的影响来影响心力衰竭的预后。然而，此前关于其对心力衰竭住院影响的数据有限。本研究旨在评估尿崩症对因心力衰竭入院患者的预后影响。我们使用了2016年至2021年的美国国家再入院数据库（NRD）。将以心力衰竭为主要诊断住院的成年患者根据是否存在尿崩症进行分层。采用倾向匹配法来平衡基线特征。使用多变量逻辑回归来估计心力衰竭合并尿崩症与临床结局、并发症、30天再入院率及医疗资源利用之间的关联。在5946749例心力衰竭住院病例中，2846例（0.04%）有尿崩症的二级诊断。与匹配的对照组相比，心力衰竭合并尿崩症的患者院内死亡率显著更高（比值比[OR]为5.77[95%置信区间，4.78 - 6.97]，<0.001）。心力衰竭合并尿崩症的患者与急性肾损伤（OR 2.11[95%置信区间，1.86 - 2.39]，<0.001）、高钠血症（OR 4.98[95%置信区间，1.86 - 2.39]，<0.001）、心源性休克（OR 1.69[95%置信区间，1.32 - 2.15]，<0.001）及脑水肿（OR 22.28[95%置信区间，14.74 - 33.69]，<0.001）的发生几率增加也相关。在全因再入院方面未发现差异（OR 0.89[95%置信区间，0.76 - 1.04]，P = 0.14），但尿崩症患者心力衰竭再入院风险较低（OR 0.47[95%置信区间，0.33 - 0.66]，<0.001），非心脏原因再入院风险较高（OR
