The association between acute-to-chronic glycemic ratio and outcome in acute heart failure

Abstract

Abstract Introduction Elevated blood glucose level on admission worsen outcome in acute heart failure (AHF). The admission blood glucose (ABG)/ the estimated average glucose (eAG) ratio which combines both acute and chronic glucose levels is attracting attention as a newly introduced glycemic index. It may be accepted as indicating the true acute glycemic rise in critically in all patients. Purpose The aim of this study was to assess the association between acute-to-chronic glycemic ratio and outcome in AHF. Methods This study assessed consecutive patients with AHF. The ABG/ eAG ratio was determined as ABG divided by eAG. We examined the relationship between ABG/ eAG ratio and all-cause mortality and readmission for heart failure within 30 days. Results A total of 249 patients with AHF (mean age; 81 years, 50% male and 37% DM) were studied. 31 (12.4%) patients had events within 30 days [18 (7.2%) died and 13 (5.2%) readmitted for HF]. We divided into three tertiles [T1 (<0.93), T2 (0.93–1.21) and T3 (>1.21)] based on the ABG/ eAG ratio. There was a stepwise worsening of the 30 days outcome [1 patient (0.4%) vs 7 patients (2.8%) vs 23 patients (9.2%), p<0.0001]. In multiple variable analysis, ABG/ eAG ratio was an independent predictor of the events (p=0.002). A cut-off value of the ABG/ eAG ratio <1.11 had a sensitivity of 94% and specificity of 67% for the increase of events within 30 days. In full model, the ABG/ eAG ratio was independent predictor of 30 days outcome in AHF (odds ratio: 11.7; 95% confidence interval: 3.65–37.5; p<0.0001). Conclusion ABG/ eAG ratio was one of the strong predictors 30 days outcome in AHF. Elevated blood glucose in the acute phase evaluated using the ABG/ eAG ratiocan enhance affect outcome and it could be a potential therapeutic target in patients of AHF. Funding Acknowledgement Type of funding source: None