Abstract
Background: To investigate the impact of admission hyperglycemia (HGL) on in-hospital death (IHD) and 1-year mortality in acute heart failure (AHF) patients with or without diabetes mellitus (DM). Methods: Among 5625 AHF patients enrolled in a nationwide registry, 5541 patients were divided into four groups based on the presence of admission HGL and diabetes mellitus (DM). Admission HGL was defined as admission glucose level > 200 mg/dL. IHD and 1-year mortality were compared. Results: IHD developed in 269 patients (4.9%), and 1-year death developed in 1220 patients (22.2%). DM was a significant predictor of 1-year death (24.8% in DM vs. 20.5% in non-DM, p < 0.001), but not for IHD. Interestingly, admission HGL was a significant predictor of both IHD (7.6% vs. 4.2%, p < 0.001) and 1-year death (26.2% vs. 21.3%, p = 0.001). Admission HGL was a significant predictor of IHD in both DM and non-DM group, whereas admission HGL was a significant predictor of 1-year death only in non-DM (27.8% vs. 19.9%, p = 0.003), but not in DM group. In multivariate analysis, admission HGL was an independent predictor of 1-year mortality in non-DM patients (HR 1.32, 95% CI 1.03–1.69, p = 0.030). Conclusion: Admission HGL was a significant predictor of IHD and 1-year death in patients with AHF, whereas DM was only a predictor of 1-year death. Admission HGL was an independent predictor of 1-year mortality in non-DM patients with AHF, but not in DM patients. Careful monitoring and intensive medical therapy should be considered in AHF patients with admission HGL, regardless of DM.
Highlights
Blood glucose level can be transiently elevated because of stress response to acute illness, so-called stress hyperglycemia (HGL)
Irrespective of diabetes mellitus (DM), admission HGL was a significant predictor of in-hospital death (IHD) in acute heart failure (AHF), but DM was not a predictor of IHD
Kosiborod et al reported that they found no significant association between admission glucose levels and mortality in a large cohort of 50,532 elderly patients hospitalized with heart failure [9]
Summary
Blood glucose level can be transiently elevated because of stress response to acute illness, so-called stress hyperglycemia (HGL). Pathological stress states may induce a metabolic state similar to diabetes with HGL and poor insulin responses to glucose challenge [6]. For these reasons, admission HGL can develop and reflect the degree or status of SNS activation in patients with AHF. If the higher admission glucose can reflect the higher SNS activation, it is presumed that admission HGL might be associated with clinical outcomes in patients with AHF. The aim of this study, was to investigate the impact of admission HGL on clinical outcomes including in-hospital and long-term mortality in AHF patients with or without DM by analyzing the data from the nationwide large AHF cohort registry
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
