Abstract
Background: Diabetes mellitus (DM) has a high morbidity and mortality worldwide, and it is a risk factor for cardiovascular diseases. Non-diabetic stress hyperglycemia is common in severely ill patients, and it could affect prognosis. This study aimed to analyze the influence of different blood glucose levels on prognosis from the perspective of stress hyperglycemia by comparing them with normal blood glucose levels and those of patients with DM.Methods: A retrospective study of 1,401 patients in coronary care unit (CCU) from the critical care database called Medical Information Mart for Intensive Care IV was performed. Patients were assigned to the following groups 1–4 based on their history of DM, random blood glucose, and HbA1c levels: normal blood glucose group, moderate stress hyperglycemia group, severe stress hyperglycemia group and DM group. The main outcome of this study was 30- and 90-day mortality rates. The associations between groups and outcomes were analyzed using Kaplan–Meier survival analysis, Cox proportional hazard regression model and competing risk regression model.Results: A total of 1,401 patients in CCU were enrolled in this study. The Kaplan–Meier survival curve showed that group 1 had a higher survival probability than groups 3 and 4 in terms of 30- and 90-day mortalities. After controlling the potential confounders in Cox regression, groups 3 and 4 had a statistically significant higher risk of both mortalities than group 1, while no difference in mortality risk was found between groups 2 and 1. The hazard ratios [95% confidence interval (CI)] of 30- and 90-day mortality rates for group 3 were 2.77(1.39,5.54) and 2.59(1.31,5.12), respectively, while those for group 4 were 1.92(1.08,3.40) and 1.94(1.11,3.37), respectively.Conclusions: Severe stress hyperglycemia (≥200 mg/dL) in patients without DM in CCU may increase the risk of short-term death, which is greater than the prognostic effect in patients with diabetes. Patients with normal blood glucose levels and moderate stress hyperglycemia (140 mg/dL ≤ RBG <200 mg/dL) had no effect on short-term outcomes in patients with CCU.
Highlights
Diabetes mellitus (DM) has developed into one of the most common chronic diseases worldwide, with its incidence increasing from 108 million (4.7%) in 1980 to 425 million (8.5%) in 2017 and an estimated increase to 629 million in 2045 [1]
The hazard ratios (HRs) of 30- and 90-day mortalities for group 3 were 2.77 (1.39, 5.54) and 2.59 (1.31, 5.12), respectively
Considering blood glucose levels are closely associated with cardiovascular disease, 1,401 patients in CCU were selected from a large critical care medical database and adjusted for a number of potential confounders, including acute physiology score-III (APS-III) score and Comorbidity Index (COMO)
Summary
Diabetes mellitus (DM) has developed into one of the most common chronic diseases worldwide, with its incidence increasing from 108 million (4.7%) in 1980 to 425 million (8.5%) in 2017 and an estimated increase to 629 million in 2045 [1]. It has a high mortality rate [2], causing a serious burden of disease. When stress hyperglycemia exceeds 11.1 mmol/L (200 mg/dL), it is associated with poor prognosis and an increased risk of death, as evidenced by an increase in hospital mortality and an increased risk of malignant events, such as chronic heart failure or cardiogenic shock in patients with cardiovascular disease [14, 15].
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
