Association Between Elevated Blood Glucose and Outcome in Acute Heart Failure Results From an International Observational Cohort

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:61

Article

Mebazaa, Alexandre^1,2  Gayat, Etienne^1,2  Lassus, Johan³  Meas, Taly^2,4  Mueller, Christian⁵  Maggioni, Aldo⁶  Peacock, Frank⁷  Spinar, Jindrich⁸  Harjola, Veli-Pekka⁹  van Kimmenade, Roland¹⁰  Pathak, Atul¹¹  Mueller, Thomas¹²  Tavazzi, Luigi¹³  diSomma, Salvatore¹⁴  Metra, Marco¹⁵  Pascual-Figal, Domingo¹⁶  Laribi, Said¹⁷  Logeart, Damien^2,18  Nouira, Semir^19,20  Sato, Naoki²¹  Parenica, Jiri⁸  Deye, Nicolas^2,22  Boukef, Riadh¹⁸  Collet, Corinne²  Van den Berghe, Greet²³  Cohen-Solal, Alain^2,17  Januzzi, James L., Jr.²⁴ 

[1] Univ Paris Diderot, AP HP, Lariboisiere Univ Hosp, Dept Anesthesiol & Intens Care, Paris, France

[2] INSERM, UMR 942, Paris, France

[3] Univ Helsinki, Cent Hosp, Dept Med, Helsinki, Finland

[4] Univ Paris Diderot, AP HP, Lariboisiere Univ Hosp, Dept Endocrinol, Paris, France

[5] Univ Basel Hosp, Dept Internal Med, CH-4031 Basel, Switzerland

[6] ANMCO Res Ctr, Florence, Italy

[7] Cleveland Clin, Emergency Med Inst, Cleveland, OH 44106 USA

[8] Masaryk Univ, Fac Med, Univ Hosp Brno, Dept Internal Med & Cardiol, Brno, Czech Republic

[9] Univ Helsinki, Cent Hosp, Div Emergency Care, Helsinki, Finland

[10] Univ Med Ctr, Utrecht, Netherlands

[11] Toulouse Univ Hosp, Dept Cardiol, Toulouse, France

[12] Konventhosp Barmherzige Brueder, Dept Lab Med, Linz, Austria

[13] Maria Cecilia Hosp, Ettore Sansavini Hlth Sci Fdn, GVM Care & Res, Cotignola, Italy

[14] Univ Roma La Sapienza, SantAndrea Hosp, Emergency Dept, Rome, Italy

[15] Univ Brescia, Dept Expt & Appl Med, Brescia, Italy

[16] Univ Murcia, Fac Med, Dept Med, Virgen de la Arrixaca Hosp,Cardiol Serv, Murcia, Spain

[17] Univ Paris Diderot, AP HP, Lariboisiere Univ Hosp, Dept Emergency Med, Paris, France

[18] Univ Paris Diderot, AP HP, Lariboisiere Univ Hosp, Dept Cardiol, Paris, France

[19] Fattouma Bourguiba Univ Hosp, Emergency Dept, Monastir, Tunisia

[20] Fattouma Bourguiba Univ Hosp, Res Unit UR06SP21, Monastir, Tunisia

[21] Musashi Kosugi Hosp, Nippon Med Sch, Tokyo, Japan

[22] Univ Paris Diderot, AP HP, Lariboisiere Univ Hosp, Paris, France

[23] Univ Leuven, Univ Hosp Leuven, Dept Intens Care Med, Louvain, Belgium

[24] Massachusetts Gen Hosp, Div Cardiol, Boston, MA 02114 USA

关键词: acute heart failure;    blood glucose;    30-day mortality;    hyperglycemia;   

DOI  :  10.1016/j.jacc.2012.11.054

来源: Elsevier

【 摘 要 】

Objective The aim of this analysis was to assess the association between elevated blood glucose level and mortality in acute heart failure (AHF). Background Elevated blood glucose has been reported to be prognostically meaningful in patients with cardiac diagnoses, such as coronary artery disease. The short-term prognostic impact of hyperglycemia in AHF is unknown, however. Methods In a multinational cohort of AHF, we examined the ability of blood glucose concentrations at presentation to predict all-cause mortality by 30 days. Fully adjusted models for prognosis included a previous diagnosis of diabetes mellitus as a covariate. Results A total of 6,212 subjects with AHF (mean age, 72 years; 52.5% male) were studied; the median blood glucose concentration on arrival at the hospital was 7.5 mmol/l (135 mg/dl), and 41% had a previous diagnosis of diabetes mellitus (DM). After 30 days, 618 patients (10%) had died. Compared with survivors, decedents had significantly higher median blood glucose concentrations (8.9 mmol/l vs. 7.4 mmol/l; p < 0.0001). In the fully adjusted model, an elevated blood glucose level was an independent predictor of 30-day mortality in AHF (odds ratio: 2.19; 95% confidence interval: 1.69 to 2.83; p < 0.001). The risk associated with an elevated blood glucose level appeared consistent across all subgroups of patients, including patients with preserved (hazard ratio: 5.41; 95% confidence interval: 2.44 to 12.0; p < 0.0001) and impaired systolic function (hazard ratio: 2.37; 95% confidence interval: 1.57 to 3.59; p < 0.0001). Furthermore, in reclassification analyses, elevated blood glucose added significant prognostic information to clinical parameters alone (4.4% net reclassification improvement; p = 0.01). Conclusions Among patients with AHF, blood glucose concentrations at presentation are powerfully prognostic for 30-day mortality, independent of a diagnosis of diabetes mellitus or other clinical variables. Because blood glucose is easily modifiable, it may represent a valid target for therapeutic intervention. (J Am Coll Cardiol 2013;61:820-9) (C) 2013 by the American College of Cardiology Foundation

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