研究Takotsubo心肌病的“糖尿病悖论”。

Postgraduate medicine Pub Date : 2025-06-01 Epub Date: 2025-05-07 DOI:10.1080/00325481.2025.2502315
Song Peng Ang, Jia Ee Chia, Kwan Lee, Madhan Shanmugasundaram, Abhishek J Deshmukh, Chayakrit Krittanawong, Jose Iglesias, Debabrata Mukherjee, Carl J Lavie
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引用次数: 0

摘要

背景:糖尿病(DM)对Takotsubo心肌病(TC)预后的影响尚不清楚,有相互矛盾的证据表明其有保护作用或有害作用。本研究评估糖尿病与TC患者住院预后之间的关系。方法:对2016-2019年全国住院患者样本数据库进行回顾性分析,比较合并和不合并DM的TC患者的住院结局。主要结局是院内死亡率,次要结局包括心脏骤停、心源性休克和急性肾损伤(AKI)。使用倾向评分匹配(PSM)来平衡协变量,并使用多变量逻辑回归来评估DM作为死亡率的独立预测因子,结果以调整优势比(ORs)和95%置信区间(CIs)报告。结果:在63155例TC住院患者中,13380例(21.2%)涉及糖尿病患者,这些患者年龄较大,合并症发生率较高。PSM分析显示DM患者AKI的风险更高(20.13% vs. 15.91%;或者,1.33;95% ci, 1.16-1.54;p = 0.053)。多变量分析发现CKD、肝脏疾病和凝血功能障碍等合并症是死亡率的预测因素,但DM不是。结论:DM与AKI的高风险相关,但不影响TC患者的住院死亡率或主要心脏事件。这些发现表明DM对TC结果的影响是中性的,强调了进一步研究的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Investigating the 'Diabetes Paradox' in Takotsubo Cardiomyopathy.

Background: The impact of diabetes mellitus (DM) on outcomes of Takotsubo cardiomyopathy (TC) remains unclear, with conflicting evidence suggesting either protective or harmful effects. This study evaluates the association between DM and in-hospital outcomes in TC patients.

Methods: A retrospective analysis of the National Inpatient Sample database (2016-2019) was conducted to compare in-hospital outcomes in TC patients with and without DM. The primary outcome was in-hospital mortality, while secondary outcomes included cardiac arrest, cardiogenic shock, and acute kidney injury (AKI). Propensity-score matching (PSM) was applied to balance covariates, and multivariable logistic regression was used to evaluate DM as an independent predictor of mortality, with results reported as adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Of 63,155 TC hospitalizations 13,380 (21.2%) involved patients with DM, who were older and had higher rates of comorbidities. PSM analysis revealed a higher risk of AKI in DM patients (20.13% vs. 15.91%; OR, 1.33; 95% CI, 1.16-1.54; p < 0.001), with no significant differences in mortality, cardiogenic shock, or cardiac arrest. Patients with diabetic neuropathy showed a non-significant trend toward increased AKI risk (27.04% vs. 20.44%; OR, 1.44; 95% CI, 1.00-2.09; p = 0.053). Multivariable analysis identified comorbidities like CKD, liver disease, and coagulopathy as mortality predictors, but not DM.

Conclusion: DM was associated with a higher risk of AKI but did not affect in-hospital mortality or major cardiac events in TC patients. These findings suggest that DM has a neutral impact on TC outcomes, highlighting the need for further investigation.

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