心力衰竭患者应激性高血糖与一年死亡率的关系：MIMIC-IV数据库分析

Relationship between stress hyperglycemia ratio of one-year mortality in patients with heart failure: Analysis of the MIMIC-IV database.

作者信息

Wang Yimeng, Xu Wei, Wang Jingyang, Shu Yuyuan, Xin Yinjing, Yang Yanmin

机构信息

Emergency and Critical Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

PLoS One. 2025 Aug 8;20(8):e0328812. doi: 10.1371/journal.pone.0328812. eCollection 2025.

DOI:10.1371/journal.pone.0328812

PMID:40779494

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12333993/

Abstract

BACKGROUND

Stress Hyperglycemia Ratio (SHR) has been confirmed to be a predictor for adverse outcomes in cardiovascular diseases in recent years. However, the impact of SHR on one-year mortality in patients diagnosed with heart failure (HF) is still unclear. This study aims to explore the relationship between SHR and one-year mortality in HF patients, both complicated with and without diabetes mellitus (DM).

METHODS

This study enrolled 3747 patients with HF from the Medical Information Mart for Intensive Care (MIMIC-IV) database. 1865 patients were set into the group of lower SHR (SHR < 0.964) and 1882 patients were in the higher group (SHR ≥ 0.964). The primary endpoint was one-year mortality.

RESULTS

The mean age of the total study population was 69 ± 13, and 1530 (40.8%) of them were female. Finally, 188 (5.0%) patients died in the hospital and 766 (20.4%) patients died during a one-year follow-up. Patients in the higher SHR group had a longer hospital stay (2.7% vs. 2.4%, p < 0.001) and higher in-hospital mortality (8 vs. 7, p < 0.001) than those in the lower group. The Kaplan-Meier curves also show that higher SHR is associated with an elevated risk of one-year mortality in patients with HF, both in the DM and non-DM groups (all log-rank p < 0.0001). As a continuous variable, SHR was an independent predictor for one-year mortality [hazard ratio (HR), 2.893; 95% confidence interval (CI), 2.198-3.808]. Elevated SHR was significantly associated with higher risk of one-year mortality in patients with (HR, 1.499; 95% CI, 1.104-2.036) and without DM (HR, 1.300; 95% CI, 1.096-1.542), consistently. The RCS curve shows a gradual increase in the probability of one-year mortality as the value of SHR increases for HF patients.

CONCLUSION

Our findings indicated that a higher level of SHR was associated with elevated one-year mortality in HF patients both with and without DM, suggesting that SHR is a promising stratification indicator for predicting the risk of death in patients with HF.

摘要

背景

近年来，应激性高血糖比值（SHR）已被证实是心血管疾病不良预后的预测指标。然而，SHR对心力衰竭（HF）患者一年死亡率的影响仍不清楚。本研究旨在探讨SHR与HF患者一年死亡率之间的关系，这些患者合并或不合并糖尿病（DM）。

方法

本研究纳入了医学重症监护信息数据库（MIMIC-IV）中的3747例HF患者。1865例患者被分为SHR较低组（SHR＜0.964），1882例患者被分为较高组（SHR≥0.964）。主要终点是一年死亡率。

结果

研究总人群的平均年龄为69±13岁，其中1530例（40.8%）为女性。最后，188例（5.0%）患者在医院死亡，766例（20.4%）患者在一年随访期间死亡。SHR较高组患者的住院时间更长（2.7%对2.4%，p＜0.001），院内死亡率更高（8对7，p＜0.001）。Kaplan-Meier曲线还显示，在DM组和非DM组中，较高的SHR与HF患者一年死亡风险升高相关（所有对数秩检验p＜0.0001）。作为连续变量，SHR是一年死亡率的独立预测指标[风险比（HR），2.893；95%置信区间（CI），2.198 - 3.808]。SHR升高与合并DM（HR，1.499；95%CI，1.104 - 2.036）和未合并DM（HR，1.300；95%CI，1.096 - 1.542）的患者一年死亡风险较高显著相关。RCS曲线显示，随着HF患者SHR值的增加，一年死亡概率逐渐增加。