Zhenrun Zhan, Chao Lan, Yongze Zhang, Jiebin Lin, Ke Zheng, Ximei Shen, Sunjie Yan
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引用次数: 0
Abstract
Objective: The stress hyperglycemia ratio (SHR) quantifies the intensity of stress hyperglycemia by highlighting the rate of change in fasting blood glucose during stress. Several studies have validated the association of SHR with poor prognosis in cardiovascular disease. However, the value of SHR in diabetic patients with severe heart failure requiring ICU admission remains unclear. The aim of this study was to investigate the predictive value of SHR for poor prognosis in diabetic patients with heart failure.
Methods: This study was based on the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and included diabetic patients with a diagnosis of heart failure. The primary outcome event was all-cause mortality. Patients were grouped according to quartiles of SHR, and the association between SHR and all-cause mortality was assessed using restricted cubic spline analysis, survival analysis, and Cox proportional hazards regression analysis.
Results: A total of 1470 patients (55.7% male) were enrolled in this study. In-hospital mortality and intensive care unit (ICU) mortality reached 12.2% and 7.8%, respectively. In-hospital mortality was significantly higher in the highest quartile group of SHR. After correction for confounders, the risk of death was significantly higher in the highest quartile group compared with the lowest quartile group. Restricted cubic spline plot analysis showed a positive linear relationship between SHR and in-hospital and ICU mortality.
Conclusion: SHR was significantly associated with in-hospital and ICU all-cause mortality in severe patients. This finding suggests that SHR may be useful in identifying diabetic patients with severe heart failure at high risk for all-cause mortality.
目的:应激性高血糖率(stress high glycemia ratio, SHR)通过显示应激时空腹血糖的变化率来量化应激性高血糖的强度。一些研究证实了SHR与心血管疾病不良预后的关联。然而,SHR在合并重症心力衰竭的糖尿病患者中的价值尚不清楚。本研究旨在探讨SHR对糖尿病合并心力衰竭患者预后不良的预测价值。方法:本研究基于重症监护医学信息市场- iv (MIMIC-IV)数据库,纳入诊断为心力衰竭的糖尿病患者。主要结局事件为全因死亡率。根据SHR的四分位数对患者进行分组,并使用限制性三次样条分析、生存分析和Cox比例风险回归分析评估SHR与全因死亡率之间的关系。结果:共有1470例患者入组,其中男性55.7%。住院死亡率和重症监护病房(ICU)死亡率分别达到12.2%和7.8%。SHR最高四分位数组的住院死亡率明显更高。校正混杂因素后,最高四分位数组的死亡风险明显高于最低四分位数组。限制性三次样条图分析显示SHR与住院和ICU死亡率呈正线性关系。结论:SHR与重症患者院内及ICU全因死亡率显著相关。这一发现表明SHR可能有助于识别全因死亡率高的严重心力衰竭糖尿病患者。
期刊介绍:
BMC Endocrine Disorders is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of endocrine disorders, as well as related molecular genetics, pathophysiology, and epidemiology.