应激高血糖率优于血糖变异性预测急性心肌梗死患者射血分数降低的死亡率:一项回顾性队列研究

IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Weiyan Lai, Xiu Ying Peng, Hui Peng, Yang Chen
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引用次数: 0

摘要

目的应激性高血糖率(SHR)和血糖变异性(GV)是葡萄糖代谢失调的标志。本研究比较了它们对急性心肌梗死(AMI)后射血分数降低患者死亡率和心律失常事件的预测价值。材料和方法我们从MIMIC-IV数据库(v3.1, 2008-2022)中分析了1933例AMI患者的射血分数降低。主要终点是住院死亡率,次要终点包括1年全因死亡率、室性心动过速/心室颤动(VT/VF)和心脏骤停。多变量logistic回归模型评估了与住院预后的关系,而Cox比例风险模型评估了1年死亡率。限制三次样条模型考察了SHR与预后之间的非线性关系,并利用受试者工作特征曲线下的面积(AUC)分析进行了判别能力的比较。结果平均年龄67.3岁,住院期间死亡401例(20.7%),1年内死亡662例(34.2%)。调整后,与GV (OR: 1.00, 95% CI: 0.99-1.01)相比,SHR与住院死亡率的相关性最强(比值比[OR]: 1.51, 95%可信区间[CI]: 1.24-1.82)。对于1年死亡率,SHR保持了优越的表现(风险比:1.40,95% CI: 1.19-1.65),最高的不育率与风险增加显著相关。ROC分析证实SHR对死亡率终点和VT/VF的预测能力均优于其他指标,但没有指标能显著预测心脏骤停。SHR的预测价值在非糖尿病患者中更为明显。结论:在射血分数降低的ami后患者中,SHR对死亡率的预测价值优于GV,支持将其纳入个体化血糖管理的风险分层模型。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Stress Hyperglycemia Ratio Outperforms Glycemic Variability in Predicting Mortality Among Acute Myocardial Infarction Patients With Reduced Ejection Fraction: A Retrospective Cohort Study

Stress Hyperglycemia Ratio Outperforms Glycemic Variability in Predicting Mortality Among Acute Myocardial Infarction Patients With Reduced Ejection Fraction: A Retrospective Cohort Study

Aims

Stress hyperglycemia ratio (SHR) and glycemic variability (GV) are established markers of glucose metabolism dysregulation. This study compared their predictive values for mortality and arrhythmic events in patients with reduced ejection fraction following acute myocardial infarction (AMI).

Materials and Methods

We analyzed 1933 AMI patients with reduced ejection fraction from the MIMIC-IV database (v3.1, 2008–2022). The primary endpoint was in-hospital mortality, with secondary endpoints including 1-year all-cause mortality, ventricular tachycardia/ventricular fibrillation (VT/VF), and cardiac arrest. Multivariate logistic regression models evaluated associations with in-hospital outcomes, while Cox proportional hazards models assessed 1-year mortality. Restricted cubic spline models examined non-linear relationships between SHR and outcomes, with discriminative ability compared using area under the receiver operating characteristic curve (AUC) analysis.

Results

Among patients (mean age 67.3 years), 401 (20.7%) died during hospitalization and 662 (34.2%) within one year. After adjustment, SHR showed the strongest association with in-hospital mortality (odds ratio [OR]: 1.51, 95% confidence interval [CI]: 1.24–1.82) compared to GV (OR: 1.00, 95% CI: 0.99–1.01). For 1-year mortality, SHR maintained superior performance (hazard ratio: 1.40, 95% CI: 1.19–1.65), with the highest tertile significantly associated with increased risk. ROC analysis confirmed SHR's superior predictive capacity for both mortality endpoints and VT/VF, while none of the indices significantly predicted cardiac arrest. SHR's predictive value was more pronounced in non-diabetic patients.

Conclusions

In post-AMI patients with reduced ejection fraction, SHR demonstrated superior predictive value for mortality compared to GV, supporting its incorporation into risk stratification models for individualized glucose management.

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来源期刊
Journal of Diabetes
Journal of Diabetes ENDOCRINOLOGY & METABOLISM-
CiteScore
6.50
自引率
2.20%
发文量
94
审稿时长
>12 weeks
期刊介绍: Journal of Diabetes (JDB) devotes itself to diabetes research, therapeutics, and education. It aims to involve researchers and practitioners in a dialogue between East and West via all aspects of epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes, including the molecular, biochemical, and physiological aspects of diabetes. The Editorial team is international with a unique mix of Asian and Western participation. The Editors welcome submissions in form of original research articles, images, novel case reports and correspondence, and will solicit reviews, point-counterpoint, commentaries, editorials, news highlights, and educational content.
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