Decreased blood glucose at admission has a prognostic impact in patients with severely decompensated acute heart failure complicated with diabetes mellitus

Abstract

The prognostic impact of a decreased blood glucose level in acute heart failure (AHF) has not been sufficiently clarified. The data from 1234 AHF patients were examined in the present study. The blood glucose (BG) levels were evaluated at admission. The patients were divided into groups based on the following: with or without diabetes mellitus (DM), and BG level ≥ 200 mg/dl (elevated BG) or < 200 mg/dl (decreased BG). The elevated and decreased BG patients were further divided into another three groups: 200 mg/ml ≤ BG < 300 mg/dl (mild-elevated), 300 mg/ml ≤ BG < 400 mg/dl (moderate-elevated) and BG ≥ 400 mg/ml (severe-elevated); and 150 mg/ml ≤ BG < 200 mg/dl (mild-decreased), 100 mg/ml ≤ BG < 150 mg/dl (moderate-decreased) and BG < 100 mg/ml (severe-decreased), respectively. The DM patients had a significantly poorer mortality than the non-DM patients. The prognosis was different between patients with elevated or decreased BG. In DM patients with elevated BG, the severe-elevated patients had a significantly poorer prognosis than moderate- and mild-elevated patients. In the DM patients with decreased BG, the severe-decreased patients had a significantly poorer prognosis than those moderate- and mild-decreased patients. The multivariate Cox regression model showed that a severe-decreased [hazard ratio (HR) 3.245, 95% confidence interval (CI) 1.271-8.282] and severe-elevated (HR 2.300, 95% CI 1.143-4.628) status were independent predictors of 365-day mortality in AHF patients with DM. The mortality was high among AHF patients with DM. Furthermore, both severe hyperglycemia and hypoglycemia were independent predictors of the mortality in patients with AHF complicated with DM.

Prognostic Value of Admission Blood Glucose Level in Critically Ill Patients Admitted to Cardiac Intensive Care Unit according to the Presence or Absence of Diabetes Mellitus

“…The relationship between stress hyperglycemia and prognosis has been documented in various critically ill conditions such as sepsis, postsurgical state, stroke, and trauma 115. Similarly, numerous studies were performed in patients with cardiovascular disease,816 and they showed a strong relationship between BG level and prognosis. However, these studies regarding the association of admission BG level with clinical outcomes focused primarily on patients with acute coronary syndrome171819 and decompensated heart failure 2021.…”

“…The mechanism has been explained by stress hormone secretion, which reflects severity of the disease,23 and by the hyperglycemia itself, which exacerbates the cytokine, inflammatory, and oxidative stress response, potentially setting up a vicious cycle 45. Previous studies conducted in various critically ill patients showed that admission blood glucose (BG) level was related to prognosis6; however, most previous studies regarding cardiovascular disease focused on acute coronary syndrome7 or decompensated heart failure 8. Furthermore, the prognostic role of BG level may differ in diabetic versus non-diabetic patients because BG level inevitably depends on the degree of glucose control with glucose-lowering strategies in diabetic patients.…”

Clinical Significance of the Triglyceride-Glucose Index in Patients Requiring Nonsurgical Intensive Care

“…29) Therefore, hypoglycemia exerts a detrimental biological effect and was associated with adverse outcomes in patients with AHF. 30) Low TG levels may be related to nutritional condition in indi-viduals with HF. AHF in elderly populations is accompanied by numerous comorbidities, including sarcopenia, cachexia, mental disorder, and frailty.…”

Risk factors and diagnostic significance of the N-terminal pro-brain natriuretic peptide as a marker in patients with acute decompensated heart failure and diabetic kidney disease

“…При стойкой гипергликемии >10 ммоль/л мы не получили взаимосвязи данного показателя с NT-proBNP и риском развития ОДСН. Авторы одного из проспективных исследований, тем не менее, показывают, что нарастание НУП ассоциировано как низкими значениями глюкозы плазмы натощак (<5,6 ммоль/л), так и высокими (>22,4 ммоль/л) у больных ОДСН и СД 2 типа [17]. Но риск смертельных исходов в течение года был выше более чем в 3 раза у тех больных, у которых глюкоза плазмы была низкой.…”