{"title":"重症 III 期非糖尿病心衰患者入院时血糖与院内死亡率的关系:一项回顾性研究。","authors":"Yu Chen, YingZhi Wang, Fang Chen, CaiHua Chen, XinJiang Dong","doi":"10.31083/j.rcm2508275","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a primary public health issue associated with a high mortality rate. However, effective treatments still need to be developed. The optimal level of glycemic control in non-diabetic critically ill patients suffering from HF is uncertain. Therefore, this study examined the relationship between initial glucose levels and in-hospital mortality in critically ill non-diabetic patients with HF.</p><p><strong>Methods: </strong>A total of 1159 critically ill patients with HF were selected from the Medical Information Mart for Intensive Care-III (MIMIC-III) data resource and included in this study. The association between initial glucose levels and hospital mortality in seriously ill non-diabetic patients with HF was analyzed using smooth curve fittings and multivariable Cox regression. Stratified analyses were performed for age, gender, hypertension, atrial fibrillation, CHD with no MI (coronary heart disease with no myocardial infarction), renal failure, chronic obstructive pulmonary disease (COPD), estimated glomerular filtration rate (eGFR), and blood glucose concentrations.</p><p><strong>Results: </strong>The hospital mortality was identified as 14.9%. A multivariate Cox regression model, along with smooth curve fitting data, showed that the initial blood glucose demonstrated a U-shape relationship with hospitalized deaths in non-diabetic critically ill patients with HF. The turning point on the left side of the inflection point was HR 0.69, 95% CI 0.47-1.02, <i>p</i> = 0.068, and on the right side, HR 1.24, 95% CI 1.07-1.43, <i>p</i> = 0.003. Significant interactions existed for blood glucose concentrations (7-11 mmol/L) (<i>p</i>-value for interaction: 0.009). No other significant interactions were detected.</p><p><strong>Conclusions: </strong>This study demonstrated a U-shape correlation between initial blood glucose and hospital mortality in critically ill non-diabetic patients with HF. The optimal level of initial blood glucose for non-diabetic critically ill patients with HF was around 7 mmol/L.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367012/pdf/","citationCount":"0","resultStr":"{\"title\":\"Admission Blood Glucose Associated with In-Hospital Mortality in Critically III Non-Diabetic Patients with Heart Failure: A Retrospective Study.\",\"authors\":\"Yu Chen, YingZhi Wang, Fang Chen, CaiHua Chen, XinJiang Dong\",\"doi\":\"10.31083/j.rcm2508275\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Heart failure (HF) is a primary public health issue associated with a high mortality rate. However, effective treatments still need to be developed. The optimal level of glycemic control in non-diabetic critically ill patients suffering from HF is uncertain. Therefore, this study examined the relationship between initial glucose levels and in-hospital mortality in critically ill non-diabetic patients with HF.</p><p><strong>Methods: </strong>A total of 1159 critically ill patients with HF were selected from the Medical Information Mart for Intensive Care-III (MIMIC-III) data resource and included in this study. The association between initial glucose levels and hospital mortality in seriously ill non-diabetic patients with HF was analyzed using smooth curve fittings and multivariable Cox regression. Stratified analyses were performed for age, gender, hypertension, atrial fibrillation, CHD with no MI (coronary heart disease with no myocardial infarction), renal failure, chronic obstructive pulmonary disease (COPD), estimated glomerular filtration rate (eGFR), and blood glucose concentrations.</p><p><strong>Results: </strong>The hospital mortality was identified as 14.9%. A multivariate Cox regression model, along with smooth curve fitting data, showed that the initial blood glucose demonstrated a U-shape relationship with hospitalized deaths in non-diabetic critically ill patients with HF. The turning point on the left side of the inflection point was HR 0.69, 95% CI 0.47-1.02, <i>p</i> = 0.068, and on the right side, HR 1.24, 95% CI 1.07-1.43, <i>p</i> = 0.003. Significant interactions existed for blood glucose concentrations (7-11 mmol/L) (<i>p</i>-value for interaction: 0.009). No other significant interactions were detected.</p><p><strong>Conclusions: </strong>This study demonstrated a U-shape correlation between initial blood glucose and hospital mortality in critically ill non-diabetic patients with HF. The optimal level of initial blood glucose for non-diabetic critically ill patients with HF was around 7 mmol/L.</p>\",\"PeriodicalId\":20989,\"journal\":{\"name\":\"Reviews in cardiovascular medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-08-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367012/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Reviews in cardiovascular medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.31083/j.rcm2508275\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/8/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Reviews in cardiovascular medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.31083/j.rcm2508275","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景:心力衰竭(HF心力衰竭(HF)是一个主要的公共卫生问题,死亡率很高。然而,有效的治疗方法仍有待开发。非糖尿病心力衰竭重症患者的最佳血糖控制水平尚不确定。因此,本研究探讨了非糖尿病心房颤动重症患者的初始血糖水平与院内死亡率之间的关系:本研究从重症监护医学信息市场-III(MIMIC-III)的数据资源中选取了 1159 例高血压重症患者。采用平滑曲线拟合和多变量 Cox 回归分析了非糖尿病心房颤动重症患者的初始血糖水平与住院死亡率之间的关系。对年龄、性别、高血压、心房颤动、无心肌梗死的冠心病(无心肌梗死的冠心病)、肾功能衰竭、慢性阻塞性肺病(COPD)、估计肾小球滤过率(eGFR)和血糖浓度进行了分层分析:住院死亡率为 14.9%。多变量 Cox 回归模型和平滑曲线拟合数据显示,非糖尿病重症心房颤动患者的初始血糖与住院死亡率呈 U 型关系。拐点左侧的 HR 为 0.69,95% CI 为 0.47-1.02,p = 0.068;拐点右侧的 HR 为 1.24,95% CI 为 1.07-1.43,p = 0.003。血糖浓度(7-11 毫摩尔/升)存在显著的交互作用(交互作用的 p 值:0.009)。没有发现其他明显的交互作用:这项研究表明,非糖尿病心房颤动重症患者的初始血糖与住院死亡率呈 U 型相关。非糖尿病心房颤动重症患者的最佳初始血糖水平约为 7 mmol/L。
Admission Blood Glucose Associated with In-Hospital Mortality in Critically III Non-Diabetic Patients with Heart Failure: A Retrospective Study.
Background: Heart failure (HF) is a primary public health issue associated with a high mortality rate. However, effective treatments still need to be developed. The optimal level of glycemic control in non-diabetic critically ill patients suffering from HF is uncertain. Therefore, this study examined the relationship between initial glucose levels and in-hospital mortality in critically ill non-diabetic patients with HF.
Methods: A total of 1159 critically ill patients with HF were selected from the Medical Information Mart for Intensive Care-III (MIMIC-III) data resource and included in this study. The association between initial glucose levels and hospital mortality in seriously ill non-diabetic patients with HF was analyzed using smooth curve fittings and multivariable Cox regression. Stratified analyses were performed for age, gender, hypertension, atrial fibrillation, CHD with no MI (coronary heart disease with no myocardial infarction), renal failure, chronic obstructive pulmonary disease (COPD), estimated glomerular filtration rate (eGFR), and blood glucose concentrations.
Results: The hospital mortality was identified as 14.9%. A multivariate Cox regression model, along with smooth curve fitting data, showed that the initial blood glucose demonstrated a U-shape relationship with hospitalized deaths in non-diabetic critically ill patients with HF. The turning point on the left side of the inflection point was HR 0.69, 95% CI 0.47-1.02, p = 0.068, and on the right side, HR 1.24, 95% CI 1.07-1.43, p = 0.003. Significant interactions existed for blood glucose concentrations (7-11 mmol/L) (p-value for interaction: 0.009). No other significant interactions were detected.
Conclusions: This study demonstrated a U-shape correlation between initial blood glucose and hospital mortality in critically ill non-diabetic patients with HF. The optimal level of initial blood glucose for non-diabetic critically ill patients with HF was around 7 mmol/L.
期刊介绍:
RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.