Low stress hyperglycemia ratio predicts worse prognosis in diabetic acute heart failure patients
Copyright © 2023 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved..
INTRODUCTION: Acute blood glucose but not glycated hemoglobin (HbA1c) predicts poor outcome in acute heart failure (HF). The stress hyperglycemia ratio (SHR) has been proposed as a prognostic predictor in various clinical settings.
OBJECTIVES: We assessed the prognostic implications of the SHR in acute HF patients with and without diabetes.
METHODS: We performed a retrospective analysis of an acute HF registry conducted between 2009 and 2010. Estimated average glucose (eAG) was calculated as (28.7×HbA1c)-46.7 and SHR as acute blood glucose divided by eAG. The primary endpoint was all-cause mortality. Follow-up was three months. Patients were grouped by SHR tertiles (≤0.88, 0.89-1.16, and >1.16). Cox regression analysis was used to test the association of SHR (cut-off 0.88) with all-cause mortality. Analysis was stratified according to the presence of diabetes. Multivariate models were built accounting for acute blood glucose and for eAG (models 1 and 2, respectively).
RESULTS: We studied 599 patients, mean age 76±12 years, of whom 62.1% had reduced ejection fraction and 50.9% had diabetes. Median acute blood glucose, eAG and SHR were 136 (107-182) mg/dl, 131 (117-151) mg/dl, and 1.02 (0.20-3.34), respectively. During follow-up 102 (17.0%) died. In patients with diabetes, those in the lowest SHR tertile had a hazard ratio (HR) of 2.24 (95% CI: 1.05-5.22) (model 1) and 2.34 (1.25-4.38) (model 2). In patients without diabetes, the HR of three-month death in the lowest SHR tertile was 0.71 (95% CI: 0.36-1.39) and 1.02 (0.58-1.81). Significant interaction was observed between diabetes and SHR.
CONCLUSIONS: In HF patients with diabetes, a SHR ≤0.88 was associated with a more than twofold higher three-month mortality risk. No such association was found in non-diabetic patients. The presence of diabetes influences the association of the SHR with mortality.
| Errataetall: |
CommentIn: Rev Port Cardiol. 2023 May;42(5):443-444. - PMID 36639107 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:42 |
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| Enthalten in: |
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology - 42(2023), 5 vom: 15. Mai, Seite 433-441 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Cunha, Filipe M [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 02.05.2023 Date Revised 02.05.2023 published: Print-Electronic CommentIn: Rev Port Cardiol. 2023 May;42(5):443-444. - PMID 36639107 Citation Status MEDLINE |
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| doi: |
10.1016/j.repc.2022.02.013 |
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| PPN (Katalog-ID): |
NLM351457151 |
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| 245 | 1 | 0 | |a Low stress hyperglycemia ratio predicts worse prognosis in diabetic acute heart failure patients |
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| 500 | |a Date Revised 02.05.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Rev Port Cardiol. 2023 May;42(5):443-444. - PMID 36639107 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved. | ||
| 520 | |a INTRODUCTION: Acute blood glucose but not glycated hemoglobin (HbA1c) predicts poor outcome in acute heart failure (HF). The stress hyperglycemia ratio (SHR) has been proposed as a prognostic predictor in various clinical settings | ||
| 520 | |a OBJECTIVES: We assessed the prognostic implications of the SHR in acute HF patients with and without diabetes | ||
| 520 | |a METHODS: We performed a retrospective analysis of an acute HF registry conducted between 2009 and 2010. Estimated average glucose (eAG) was calculated as (28.7×HbA1c)-46.7 and SHR as acute blood glucose divided by eAG. The primary endpoint was all-cause mortality. Follow-up was three months. Patients were grouped by SHR tertiles (≤0.88, 0.89-1.16, and >1.16). Cox regression analysis was used to test the association of SHR (cut-off 0.88) with all-cause mortality. Analysis was stratified according to the presence of diabetes. Multivariate models were built accounting for acute blood glucose and for eAG (models 1 and 2, respectively) | ||
| 520 | |a RESULTS: We studied 599 patients, mean age 76±12 years, of whom 62.1% had reduced ejection fraction and 50.9% had diabetes. Median acute blood glucose, eAG and SHR were 136 (107-182) mg/dl, 131 (117-151) mg/dl, and 1.02 (0.20-3.34), respectively. During follow-up 102 (17.0%) died. In patients with diabetes, those in the lowest SHR tertile had a hazard ratio (HR) of 2.24 (95% CI: 1.05-5.22) (model 1) and 2.34 (1.25-4.38) (model 2). In patients without diabetes, the HR of three-month death in the lowest SHR tertile was 0.71 (95% CI: 0.36-1.39) and 1.02 (0.58-1.81). Significant interaction was observed between diabetes and SHR | ||
| 520 | |a CONCLUSIONS: In HF patients with diabetes, a SHR ≤0.88 was associated with a more than twofold higher three-month mortality risk. No such association was found in non-diabetic patients. The presence of diabetes influences the association of the SHR with mortality | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute blood glucose | |
| 650 | 4 | |a Diabetes | |
| 650 | 4 | |a Diabetes mellitus | |
| 650 | 4 | |a Glicemia aguda | |
| 650 | 4 | |a Glycated hemoglobin | |
| 650 | 4 | |a Heart failure | |
| 650 | 4 | |a Hemoglobina glicada | |
| 650 | 4 | |a Insuficiência cardíaca | |
| 650 | 4 | |a Prognosis | |
| 650 | 4 | |a Prognóstico | |
| 650 | 4 | |a Ratio de hiperglicemia de stress | |
| 650 | 4 | |a Stress hyperglycemia ratio | |
| 650 | 7 | |a Blood Glucose |2 NLM | |
| 650 | 7 | |a Glycated Hemoglobin |2 NLM | |
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| 700 | 1 | |a Ferreira, Inês |e verfasserin |4 aut | |
| 700 | 1 | |a Bettencourt, Paulo |e verfasserin |4 aut | |
| 700 | 1 | |a Lourenço, Patrícia |e verfasserin |4 aut | |
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