Death In Non-diabetic Patients Research Articles

The triglyceride glucose index predicts short-term mortality in non-diabetic patients with acute heart failure.

The triglyceride glucose index (TyG) has previously been considered a reliable indicator of insulin resistance (IR) and an independent prognostic predictor in heart failure (HF). To clarify the association between the TyG and short-term death in non-diabetic patients admitted for acute heart failure (AHF). We examined 886 out of 1620 consecutive AHF patients who were admitted to Shunde Hospital, Southern Medical University, Foshan, China, from June 1, 2014, to June 1, 2022. The median of the patientsf TyG values was used to divide them into 2 groups. The following formula was used to calculate the TyG: ln [fasting triglycerides (mg/dL) ~ fasting glucose (mg/dL)/2]. The data on all-cause mortality of AHF patients during their hospital stay were collected. The 30-day Enhanced Feedback for Effective Cardiac Treatment (EFFECT) death risk score was used to assess the risk of death. The TyG level was positively correlated with a poor AHF prognostic marker (N-terminal B-type natriuretic peptide (NT-proBNP)) (Ď = 0.207, p < 0.001) and negatively correlated with a protective marker (serum albumin) (Ď = .0.43, p < 0.001). Higher TyG values were associated with an elevated EFFECT score and hospital mortality (p < 0.001). According to multivariate logistic regression analysis, higher TyG levels raised the risk of death in hospital (odds ratio (OR) = 1.73; 95% confidence interval (95% CI): 1.03.3.27; p = 0.031) after adjusting for multiple variables, including age, EFFECT score and NT-proBNP. The TyG had a greater area under the receiver operating characteristic (ROC) curve (AUC: 0.688) for predicting hospital death compared to NT-proBNP (AUC: 0.506). Our findings show that the TyG is associated with the short-term mortality rate of non-diabetic patients admitted to the hospital for AHF. The TyG testing could be a useful prognostic indicator for these patients.

The triglycerides-glucose index and the triglycerides to high-density lipoprotein cholesterol ratio are both effective predictors of in-hospital death in non-diabetic patients with AMI.

The triglycerides-glucose index (TyG) and the triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) are simple indicators for assessing insulin resistance in epidemiological studies. We aimed to clarify the relationship between indicators of insulin resistance and prognosis in non-diabetic acute myocardial infarction (AMI) patients. A total of 1,648 AMI patients without diabetes were enrolled from the Department of Cardiology, Zhongda Hospital, between 2012.03 and 2018.12. The medical history, laboratory and imaging data of patients were collected through the medical record system, and all-cause death events were recorded. Pearson analysis was used to study the correlation among different variables. Logistic regression analysis was used to analyze the predictive effect of TyG and TG/HDL-C in in-hospital death of AMI patients. 1. In AMI group, the TyG index was significantly increased in death groups compared to no-death groups (P=0.025). TG/HDL-C was not significantly increased in the death group of AMI patients (P=0.588). The patients were respectively divided into Q1-Q4 groups and T1-T4 groups according to the quartiles of TyG and TG/HDL-C. The trends of in-hospital mortality in the Q4 group of TyG and T4 group of TG/HDL-C were higher than in other groups, although these differences were not significant. 2. Pearson correlation analysis showed that TyG was positively correlated with lipid-related markers, including ApoB (r=0.248, P<0.001), total cholesterol (TC) (r=0.270, P<0.001), low-density lipoprotein cholesterol (LDL-C) (r=0.238, P<0.001). Spearman analysis showed that TG/HDL-C was also positively associated with TC (r=0.107, P<0.001), ApoB (r=0.180, P<0.001) and LDL-C (r=0.164, P<0.001). 3. Logistic regression analysis showed that TyG (OR = 3.106, 95% CI [2.122-4.547], P<0.001) and TG/HDL-C (OR = 1.167, 95% CI [1.062-1.282], P=0.001) were both important factors to predict the in-hospital death of AMI patients without diabetes. TyG index and TG/HDL-C, as emerged simple markers of insulin resistance, were both important predictors of in-hospital death in AMI patients without diabetes.

Lipoprotein(a) levels and risk of adverse events after myocardial infarction in patients with and without diabetes

Abstract Background There is a positive continuous association between Lipoprotein(a) (Lp[a]) levels and the risk of recurrent ischemic events in patients with recent myocardial infarction (MI). However, the prognostic significance of the association between high Lp(a) levels and diabetes has been poorly investigated after MI. Purpose The aim of this study was to evaluate the association of Lp(a) levels with the long-term risk of adverse events in post-MI patients, and to investigate whether diabetes may influence this association. Methods Consecutive MI patients who underwent urgent/emergent coronary angiography at our Institution from February 2013 to June 2019 were prospectively collected. Lp(a) serum concentrations was expressed for increasing range values (≤10, &amp;gt;10–30, &amp;gt;30–50, &amp;gt;50–70, and ≥70 mg/dL). The primary outcome was the recurrence of MI; the secondary outcome was all-cause death. The propensity score weighting technique was used to account for potential confounding between patients with and without diabetes. Results The study population consisted of 1018 post-MI patients (median age: 63 years; 76% males). Diabetes was reported in 280 patients (27.5%). The median value of Lp(a) was 10 mg/dL, and patients with diabetes showed significantly lower Lp(a) levels than patients without diabetes (p=0.025). At a median follow-up of 1121 days, the primary outcome was reported in 109 patients (10.7%), and the secondary outcome in 100 (9.8%). After propensity score weighting, there was a significant association between increasing Lp(a) range values and the primary outcome both in the overall population (p trend = 0.030) and in non-diabetic patients (p trend = 0.009), but not in diabetics. Conversely, no significant association with the risk of all-cause mortality across increasing Lp(a) categories both in the overall population and in the study groups according to the presence or not of diabetes was found. Compared with the lowest Lp(a) category, Lp(a) plasma levels &amp;gt;70 mg/dL were independently associated with the risk of recurrent MI (HR: 3.222; 95% CI, 1.225–8.478, p=0.018) and all-cause death (HR: 2.656; 95% CI, 1.009–6.991, p=0.048) in non-diabetic patients, but not in diabetics. Conclusions In this real-world post-MI population, Lp(a) serum levels were lower in diabetic than in non-diabetic patients. Increasing Lp(a) levels were significantly associated with the risk of recurrent MI, and very high Lp(a) serum concentration (&amp;gt;70 mg/dL) independently predicted recurrent MI and death in non-diabetic patients, but not in diabetics. These results reinforce the importance of routine assessment of Lp(a) levels after MI, particularly in patients without diabetes. Funding Acknowledgement Type of funding sources: None.

Prediction of 90-day mortality in patients without diabetes by severe hypoglycemia: blood glucose level as a novel marker of severity of underlying disease.

AimThe present study examined the clinical conditions and predictors of death in non-diabetic patients with pre-hospital severe hypoglycemia.Materials and methodsFrom January 2006 to March 2012, we retrospectively reviewed the medical records to assess the patients with pre-hospital severe hypoglycemia at a national center in Japan. Severe hypoglycemia was defined as the presence of any hypoglycemic symptoms requiring the medical assistance of another person. The patients were followed up for 90 days after the severe hypoglycemia episode.ResultsA total of 59,602 consecutive cases that visited the emergency room were screened, and 530 patients with severe hypoglycemia were included in the subsequent analysis. The mean blood glucose levels in the non-diabetes (non-DM, n = 163) and diabetes (DM, n = 367) groups were 42.9 and 33.7 mg/dL, respectively. The incidence of extremely abnormal QT prolongation (corrected QT interval ≥0.50 s) was high in both groups [22.1 vs. 14.7 % (P = 0.11)]. Mortalities within 90 days after severe hypoglycemia were significantly higher in the non-DM group than in the DM group [20.3 vs. 1.6 % (P < 0.001)]. In addition to patient age, preexisting advanced liver disease and cancer, and the coexistence of sepsis, a blood glucose level of <40 mg/dL was identified as a strong predictor of death in the non-DM group using multivariate Cox proportional hazards models (hazard ratio 3.75; 95 % confidence interval 1.52–9.27; P = 0.004).ConclusionsDeath in non-diabetic patients with severe hypoglycemia was independently associated not only with age, advanced liver disease, cancer, and sepsis, but also with the blood glucose level upon arrival.

Cardiovascular and mortality risk in elderly Medicare beneficiaries treated with olmesartan versus other angiotensin receptor blockers

In the randomized trial, Randomized Olmesartan and Diabetes Microalbuminuria Prevention, acute cardiovascular death was increased nearly fivefold in diabetic patients treated with high-dose olmesartan, an angiotensin receptor blocker (ARB), compared with placebo. Medicare beneficiaries were entered into new-user cohorts of olmesartan or other ARBs and followed on therapy for occurrence of acute myocardial infarction, stroke, or death. Analyses focused on specific subgroups defined by diabetes status, ARB dose, and duration of therapy. Hazard ratios (HR) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression, with other ARBs as reference. A total of 158,054 olmesartan and 724,673 other ARB users were followed for 54,285 and 260,390 person-years, respectively, during which 9237 endpoint events occurred. Lower-dose olmesartan was not associated with increased risk for any endpoint, regardless of duration of use. High-dose olmesartan for 6 months or longer was associated with increased risk of death in patients with diabetes (HR 2.03, 95%CI 1.09-3.75, p = 0.02) and with reduced risk in nondiabetic patients (HR 0.46, 95%CI 0.24-0.86, p = 0.01). Some, but not all, sensitivity analyses suggested that selective prescribing of olmesartan to healthier patients (channeling bias) may have accounted for the reduced risk in nondiabetic patients. High-dose olmesartan was associated with an increased risk of death in diabetic patients treated for 6 months or longer and with a reduced risk of death in nondiabetic patients, when compared with use of other ARBs. This latter effect was probably because of selective prescribing of olmesartan to healthier patients, although effect modification cannot be excluded. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Is the Blood Pressure Paradox Observed in All Heart Failure Patients?

Background. Heart failure (HF) patients with higher systolic blood pressure (SBP) survive longer. Diabetes mellitus (DM) is a frequent comorbidity in HF. We evaluated the prognostic significance of low SBP according to DM in acute HF. Methods. We prospectively recruited 589 patients admitted with acute HF. DM was defined according to the 2011 American Diabetes Association recommendations. Patients were followed for 6 months and HF-death was the endpoint. A multivariate Cox-regression model was used to assess the prognostic impact of SBP. A stratified analysis according to DM was performed. Results. Median patients' age was 79 years and DM was present in 50.8%. Ischemic aetiology HF and hypertension history were more common in diabetics. Diabetic patients had worse renal function and lower total cholesterol and were more often discharged with antiplatelet therapy and statin. During followup, 89 patients died due to HF. The multivariate-adjusted HR for the 6-month HF death in non-diabetic patients with an admission SBP < 115 mmHg (1st quartile) was 2.94 (95% CI: 1.49–5.79), while lower admission SBP was not associated with HF mortality in diabetics. Conclusions. The blood pressure paradox in HF is only observed in non-diabetic HF patients. Diabetic patients seem to be a particular subgroup of HF patients.

Effects of admission glucose level on mortality after subarachnoid hemorrhage: A comparison between short-term and long-term mortality

BackgroundAdmission hyperglycemia is associated with poor functional outcomes and risk of death in nondiabetic patients with acute ischemic stroke. However, there is still some debate about the effects of hyperglycemia in subarachnoid hemorrhage (SAH) patients. The purpose of this study was to assess whether the admission glucose level in patients with SAH is associated with short- and/or long-term mortality. MethodsA consecutive data set of SAH patients without diabetes was obtained from a prospective multicenter cohort of hemorrhagic stroke patients. The effects of glucose level were examined in relation to short- (30 days) or long-term mortality using Cox regression analysis. To eliminate the short-term effects of glucose level, the long-term effects were analyzed in the patients who survived for more than 30 days. ResultsA total of 803 SAH patients were followed up in this study. The 30-day and final mortalities were 7.6% and 12.0%, respectively. Throughout the entire follow-up period, glucose level was found to be significantly associated with final mortality after adjusting for potential confounders (adjusted HR, 1.10; 95% CI, 1.01 to 1.19). Moreover, glucose level was found to be associated with short-term mortality (adjusted HR, 1.15; 95% CI, 1.05 to 1.27), but not with long-term mortality (adjusted HR, 0.97; 95% CI, 0.82 to 1.14). ConclusionsWe demonstrated that admission hyperglycemia has a harmful effect on short-term mortality, but not with long-term mortality in SAH patients without diabetes. Our results may be used as further evidence to support a hypothesis of harmful effects of hyperglycemia in SAH patients.

Postoperative hyperglycaemia - a marker of increased risk of complication or death in non-diabetic patients following coronary artery surgery

Postoperative hyperglycaemia - a marker of increased risk of complication or death in non-diabetic patients following coronary artery surgery

Urea index and other predictors of hemodialysis patient survival.

The mortality of dialysis patients in the United States has been a concern since the US Renal Data System 1989 report, which showed a lower survival rate in the United States compared with Europe. The differences were thought to be multifactorial, including case mix, malnutrition, and adequacy of dialysis. We reviewed the Regional Kidney Disease Program's 1976 to 1989 database for the pattern of co-morbidity, dialysis therapy, and low serum albumin in 1,082 nondiabetic and 691 diabetic patients followed to September 15, 1991. The number of patients over 60 years of age has increased by 15% to 20% per year since 1982. The primary renal diagnoses for nondiabetic patients have shifted from 26% glomerulonephritis, 18% vascular and hypertension, and 15% interstitial kidney disease cases during the period from 1976 to 1982 to 19% glomerulonephritis, 35% vascular and hypertension, and 10% interstitial disease cases during the period from 1986 to 1989. Co-morbidity as single and multiple conditions has increased from 66% to 85% in diabetic patients and from 57% to 66% in nondiabetic patients. The number of patients with two or more co-morbid conditions has increased 1.5-fold in nondiabetic patients and twofold in diabetic patients from the 1976 to 1982 period to the 1986 to 1989 period. Urea index and albumin were determined for these patients and were averaged as a risk factor. A Cox regression analysis was used to determine the relative risk of death of such characteristics as age, renal diagnosis, co-morbidity, urea index (KT/V), and albumin in nondiabetic and diabetic patients. Urea index was divided into ranges of less than 1.0 (mean, 0.9), 1.0 to less than 1.2, 1.2 to less than 1.4, and > or = 1.4 (mean, 1.6). The relative risk of death in nondiabetic patients was 0.65 (P = 0.0012) for KT/V 1.2 to less than 1.4 and 0.67 (P = 0.0029) for KT/V > or = 1.4 (mean, 1.6) compared with 1.0 to less than 1.2 as the baseline. In the diabetic patients, the relative risk of death was 0.70 (P = 0.009) for KT/V 1.2 to less than 1.4 and 0.59 (P = 0.0001) for KT/V > or = 1.4 (mean, 1.6) compared with 1.0 to less than 1.2. In the diabetic patients, KT/V > or = 1.4 also was significantly different from 1.2 to less than 1.4 as it impacted on death rates.(ABSTRACT TRUNCATED AT 400 WORDS)