Abstract
BackgroundDiabetes is prevalent worldwide including hospitalized patients with heart failure with reduced ejection fraction (HFrEF). This retrospective study investigated the association of diabetes with in-hospital adverse events in patients with HFrEF.MethodsWe analyzed data from electronic medical records of patients hospitalized with HFrEF in West China Hospital of Sichuan University from January 1, 2011, to September 30, 2018. Propensity score matching balances the baseline characteristics between patients with and without diabetes. Logistic and Poisson regressions investigated the association of diabetes with risks of intubation, cardiogenic shock, acute kidney injury (AKI), intensive care unit (ICU) admission and death during hospitalization, and length of ICU and hospital stay in the matched cases.ResultsAmong 6,022 eligible patients (including 1,998 with diabetes), 1,930 patient pairs with and without diabetes were included by propensity score matching. Patients with diabetes had a significantly increased risk of intubation (odds ratio [OR], 2.69; 95% confidence interval [CI], 2.25–3.22; P<0.001), cardiogenic shock (OR, 2.01; 95% CI, 1.72–2.35; P<0.001), AKI at any stage (OR, 1.67; 95% CI, 1.44–1.94; P<0.001), ICU admission (OR, 1.89; 95% CI, 1.65–2.15; P<0.001), and death (OR, 4.25; 95% CI, 3.06–6.02; P<0.001) during hospitalization. Patients with diabetes had longer ICU (median difference, 1.47 days; 95% CI, 0.96–2.08; P<0.001) and hospital stay (2.20 days; 95% CI, 1.43–2.86; P<0.001) than those without diabetes. There were potential subgroup effects by age and by hypertension, and CKD status on the association of diabetes with risk of AKI at any stage; and subgroup effects by sex and CKD status on the association of diabetes with risk of intubation. The increase in length of hospital stay was larger in patients without hypertension than those with hypertension.ConclusionsAmong patients with HFrEF, those with diabetes have a worse prognosis, including a higher risk of in-hospital intubation, cardiogenic shock, AKI, ICU admission and death during hospitalization, and longer ICU and hospital stay.
Highlights
Diabetes is a common comorbidity of heart failure (HF) and is present in more than 40% of patients with HF, representing an increasing disease burden worldwide [1,2,3,4,5,6]
We examined the impact of diabetes on in-hospital adverse events in subgroups stratified by sex, age, +/− HD, +/− hypertension, and +/− CKD, which was defined as estimated glomerular rate filtration (eGFR)
After PS matching (PSM), diabetes was found to be significantly associated with higher risks of intubation
Summary
Diabetes is a common comorbidity of heart failure (HF) and is present in more than 40% of patients with HF, representing an increasing disease burden worldwide [1,2,3,4,5,6]. Other lesions that are highly related to diabetes myocardial fibrosis and microangiopathy, injures the function of the heart, causing and exacerbating HF [8, 15, 16]. It remains unclear whether and how these pathophysiological changes of diabetes translate into the clinical practice in patients with HFrEF. Diabetes is prevalent worldwide including hospitalized patients with heart failure with reduced ejection fraction (HFrEF). This retrospective study investigated the association of diabetes with in-hospital adverse events in patients with HFrEF
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