Admission Hyperglycemia as a Predictor of Mortality in Acute Heart Failure: Comparison between the Diabetics and Non-Diabetics
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Data Collection
2.3. Echocardiographic Measurements
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Echocardiographic Findings
3.3. Prescribed Medications
Impacts of DM and Admission HGL on IHD and 1-Year Death
3.4. Impacts of DM and Admission HGL on 1-Year Mortality According to HF Subtypes
4. Discussion
4.1. Admission HGL or DM and IHD
4.2. Admission HGL or DM and 1-Year Death
4.3. HGL and Increased SNS Affecting HF Mortality
4.4. Impacts of DM and Admission HGL on 1-Year Mortality According to HF Subtypes
5. Study Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Variables | DM (n = 2125) | No DM (n = 3416) | ||||
---|---|---|---|---|---|---|
Admission HGL (n = 799) | No Admission HGL (n = 1326) | p | Admission HGL (n = 248) | No Admission HGL (n = 3168) | p | |
Age (years) | 70.8 ± 11.3 | 70.2 ± 11.5 | 0.223 | 72.9 ± 12.9 | 67.0 ± 16.1 | <0.001 |
Male sex (%) | 400 (50.1) | 757 (57.1) | 0.002 | 115 (46.4) | 1670 (52.7) | 0.054 |
Body mass index (kg/m2) | 23.6 ± 3.6 | 24.0 ± 4.0 | 0.017 | 22.5 ± 3.3 | 23.0 ± 3.9 | 0.014 |
Systolic blood pressure (mmHg) | 138.1 ± 33.0 | 132.1 ± 29.3 | <0.001 | 139.0 ± 36.6 | 128.5 ± 29.1 | <0.001 |
Diastolic blood pressure (mmHg) | 79.9 ± 19.7 | 78.1 ± 17.6 | 0.035 | 82.3 ± 20.3 | 78.2 ± 18.8 | 0.003 |
Heart rate (bpm) | 98.2 ± 26.9 | 90.4 ± 23.9 | <0.001 | 102.3 ± 28.8 | 91.5 ± 26.0 | <0.001 |
Hypertension | 586 (73.3) | 985 (74.3) | 0.632 | 145 (58.5) | 1564 (49.4) | 0.006 |
Heart failure history | 326 (40.8) | 660 (49.8) | <0.001 | 84 (33.9) | 1338 (42.2) | 0.010 |
Dyslipidemia | 645 (52.9) | 443 (59.8) | 0.003 | 97 (44.7) | 984 (34.7) | 0.003 |
Smoking history | 304 (38.0) | 550 (41.5) | 0.118 | 99 (39.9) | 1187 (37.5) | 0.443 |
Alcohol history | 278 (34.8) | 502 (37.9) | 0.156 | 78 (31.5) | 1264 (39.9) | 0.009 |
Valvular heart disease | 72 (9.0) | 165 (12.4) | 0.015 | 21 (8.5) | 542 (17.1) | <0.001 |
Cerebrovascular disease | 139 (17.4) | 253 (19.1) | 0.333 | 34 (13.7) | 414 (13.1) | 0.775 |
Ischemic heart disease | 304 (38.0) | 535 (40.3) | 0.294 | 68 (27.4) | 654 (20.7) | 0.012 |
Chronic kidney disease | 169 (21.2) | 302 (22.8) | 0.383 | 19 (7.7) | 304 (9.6) | 0.316 |
Atrial fibrillation | 145 (18.1) | 392 (29.6) | <0.001 | 54 (21.8) | 941 (29.7) | 0.008 |
Serum glucose (mg/dL) | 291.1 ± 87.3 | 137.1 ± 36.0 | <0.001 | 259.1 ± 61.2 | 120.8 ± 27.8 | <0.001 |
Hb A1c (%) | 8.0 ± 1.6 | 6.9 ± 1.0 | <0.001 | 5.8 ± 0.3 | 5.8 ± 0.4 | 0.764 |
Serum creatinine (mg/dL) | 1.8 ± 1.6 | 1.7 ± 1.6 | 0.373 | 1.5 ± 1.4 | 1.3 ± 1.4 | 0.132 |
Glomerular filtration rate (ml/min) | 61.0 ± 36.1 | 66.0 ± 39.9 | 0.004 | 67.1 ± 33.7 | 79.6 ± 40.0 | <0.001 |
High-sensitivity C-reactive protein* | 1.02 (0.26–3.71) | 0.67 (0.23–2.24) | <0.001 | 0.88 (0.24–2.41) | 0.58 (0.18–2.00) | 0.684 |
Brain natriuretic peptide* | 993.8 (617.3–1845.5) | 893.3 (470.0–1685.8) | 0.213 | 1004.4 (521.5–2120.0) | 884.3 (447.1–1732.1) | 0.188 |
N-terminal Pro-B type natriuretic peptide* | 6198.3 (2441.5–15,835.3) | 5365.0 (2344.0–13,443.0) | 0.186 | 5983.0 (2361.0–13,833.0) | 4497.0 (2031.0–10,416.0) | 0.166 |
Troponin-I* | 0.13 (0.05–1.20) | 0.06 (0.03–0.21) | 0.189 | 0.11 (0.05–0.76) | 0.05 (0.03–0.19) | 0.301 |
Variables | DM (n = 2125) | No DM (n = 3416) | ||||
---|---|---|---|---|---|---|
Admission HGL (n = 799) | No Admission HGL (n = 1326) | p | Admission HGL (n = 248) | No Admission HGL (n = 3168) | p | |
LVEDD (mm) | 56.2 ± 8.9 | 57.9 ± 9.2 | <0.001 | 55.9 ± 9.7 | 57.5 ± 10.7 | 0.018 |
LVESD (mm) | 44.1 ± 11.0 | 45.8 ± 11.6 | 0.001 | 43.5 ± 11.3 | 45.1 ± 13.0 | 0.047 |
LVEF (%) | 36.8 ± 14.5 | 36.8 ± 15.1 | 0.996 | 37.0 ± 14.5 | 38.7 ± 16.1 | 0.081 |
LA dimension (mm) | 45.7 ± 8.3 | 48.7 ± 9.0 | <0.001 | 45.8 ± 10.6 | 48.7 ± 10.3 | <0.001 |
E (m/s) | 0.93 ± 0.35 | 0.96 ± 0.36 | 0.156 | 0.82 ± 0.33 | 0.95 ± 0.41 | <0.001 |
DT (msec) | 162.4 ± 59.5 | 167.5 ± 70.7 | 0.157 | 171.3 ± 69.7 | 172.1 ± 89.9 | 0.900 |
E’ (cm/s) | 4.8 ± 3.4 | 4.7 ± 1.9 | 0.746 | 4.7 ± 1.9 | 5.2 ± 2.2 | 0.003 |
S’ (cm/s) | 4.8 ± 1.8 | 5.1 ± 1.9 | 0.020 | 5.2 ± 2.0 | 5.1 ± 2.1 | 0.835 |
E/E’ | 22.3 ± 11.0 | 22.8 ± 12.6 | 0.401 | 19.1 ± 8.5 | 20.5 ± 11.3 | 0.039 |
SPAP (mmHg) | 44.2 ± 14.6 | 45.2 ± 15.5 | 0.237 | 41.2 ± 14.3 | 43.5 ± 15.0 | 0.056 |
Variables | DM (n = 2125) | Non-DM (n = 3416) | ||||
---|---|---|---|---|---|---|
Odd Ratio | 95% CI | p | Odd Ratio | 95% CI | p | |
Age > 75 years | 1.72 | 1.07–2.79 | 0.026 | 0.92 | 0.65–1.30 | 0.625 |
Male sex | 1.08 | 0.67–1.75 | 0.739 | 1.43 | 1.02–2.01 | 0.036 |
History of hypertension | 0.98 | 0.59–1.62 | 0.927 | 0.94 | 0.67–1.33 | 0.740 |
Systolic blood pressure < 100 mmHg | 3.59 | 2.17–5.93 | <0.001 | 2.88 | 2.06–4.05 | <0.001 |
Renal insufficiency (initial GFR < 60 mL/min) | 1.70 | 1.05–2.76 | 0.030 | 2.14 | 1.53–2.99 | <0.001 |
Admission hyperglycemia | 1.84 | 1.11–3.05 | 0.017 | 2.26 | 1.47–3.48 | <0.001 |
Hb A1c | 0.83 | 0.68–1.02 | 0.080 | |||
Ischemic etiology | 1.88 | 1.16–3.04 | 0.010 | 1.91 | 1.37–2.68 | 0.74 |
Variables | Hazard Ratio | 95% CI | p |
---|---|---|---|
Age > 75 years | 1.94 | 1.65–2.29 | <0.001 |
Male sex | 1.41 | 1.21–1.64 | <0.001 |
Systolic blood pressure < 100 mmHg | 1.84 | 1.54–2.20 | <0.001 |
Renal insufficiency (initial GFR < 60 mL/min) | 1.82 | 1.55–2.13 | <0.001 |
Admission HGL | 1.32 | 1.03–1.69 | 0.030 |
No RAS inhibitors | 2.13 | 1.78–2.55 | <0.001 |
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Cho, J.Y.; Kim, K.H.; Lee, S.E.; Cho, H.-J.; Lee, H.-Y.; Choi, J.-O.; Jeon, E.-S.; Kim, M.-S.; Kim, J.-J.; Hwang, K.-K.; et al. Admission Hyperglycemia as a Predictor of Mortality in Acute Heart Failure: Comparison between the Diabetics and Non-Diabetics. J. Clin. Med. 2020, 9, 149. https://doi.org/10.3390/jcm9010149
Cho JY, Kim KH, Lee SE, Cho H-J, Lee H-Y, Choi J-O, Jeon E-S, Kim M-S, Kim J-J, Hwang K-K, et al. Admission Hyperglycemia as a Predictor of Mortality in Acute Heart Failure: Comparison between the Diabetics and Non-Diabetics. Journal of Clinical Medicine. 2020; 9(1):149. https://doi.org/10.3390/jcm9010149
Chicago/Turabian StyleCho, Jae Yeong, Kye Hun Kim, Sang Eun Lee, Hyun-Jai Cho, Hae-Young Lee, Jin-Oh Choi, Eun-Seok Jeon, Min-Seok Kim, Jae-Joong Kim, Kyung-Kuk Hwang, and et al. 2020. "Admission Hyperglycemia as a Predictor of Mortality in Acute Heart Failure: Comparison between the Diabetics and Non-Diabetics" Journal of Clinical Medicine 9, no. 1: 149. https://doi.org/10.3390/jcm9010149
APA StyleCho, J. Y., Kim, K. H., Lee, S. E., Cho, H.-J., Lee, H.-Y., Choi, J.-O., Jeon, E.-S., Kim, M.-S., Kim, J.-J., Hwang, K.-K., Chae, S. C., Baek, S. H., Kang, S.-M., Choi, D.-J., Yoo, B.-S., Ahn, Y., Park, H.-Y., Cho, M.-C., & Oh, B.-H. (2020). Admission Hyperglycemia as a Predictor of Mortality in Acute Heart Failure: Comparison between the Diabetics and Non-Diabetics. Journal of Clinical Medicine, 9(1), 149. https://doi.org/10.3390/jcm9010149