主页 > 医学动态 >
【文摘发布】入院时血糖水平与心衰患者预后密
C Berry1, M Brett1, K Stevenson1, J J V McMurray1, J Norrie2
1 Department of Cardiology, Western Infirmary, Glasgow, Scotland
2 Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland
Objective: To investigate the nature and importance of blood glucose abnormalities in an unselected heart failure (HF) population.
Design: Cohort study.
Setting: Urban University hospital.
Patients: All index emergency HF admissions to one University hospital during the year 2000 were studied.
Results: 454 consecutive index admissions had blood chemistry, diabetic status and follow-up information recorded. 390 (86%) patients had an echocardiogram, of whom 117 (30%) had preserved left ventricular systolic function and 110 (24%) had diabetes. Sixty (13%) patients had abnormal glucose tolerance (8.0–10.99 mmol/l), and 284 (63%) patients had a normal admission blood glucose (<8 mmol/l). 51 (11.2%) patients died in hospital. After adjustment for other prognostic attributes, abnormal glucose tolerance (Cox hazard ratio HR, 95% CI: 5.920, 1.03 to 34.00; p = 0.046) but not diabetes (HR 3.46, 0.75 to 16.02; p = 0.112) predicted in-hospital mortality. During follow-up (median 812 (range 632–978) days), 104 (36.6%), 30 (50.0%) and 55 (50%) patients with a normal admission blood glucose concentration, abnormal glucose tolerance and diabetes, respectively, died (log rank test p = 0.0037, adjusted p = 0.075). Compared with patients with normal admission blood glucose, abnormal glucose tolerance (adjusted HR: 1.41 (0.92 to 2.16); p = 0.12) and diabetes (adjusted HR: 2.02 (1.41 to 2.88); p = 0.0001) predicted mortality. Considering glucose on admission as a continuous covariate, a 2 mmol/l increase was associated with a HR of 1.08 (1.03 to 1.13), p = 0.0010, which after adjustment for the above covariates became 1.08 (1.03 to 1.13), p = 0.0023.
Conclusions: Admission blood glucose concentration and diabetes are prognostically important in HF and could help target some patients for more intensive therapy.
Heart 2008;94:296-304 Nature and prognostic importance of abnormal glucose tolerance and diabetes in acute heart failure
糖耐量异常和糖尿病在急性心衰患者中的特征及其重要预测价值.
Objective: To investigate the nature and importance of blood glucose abnormalities in an unselected heart failure (HF) population.
目的: 研究在未经选择的心衰人群中血糖异常的特征和重要性.
Design: Cohort study.
设计: 队列研究.
Setting: Urban University hospital.
地点: 城市大学医院
Patients: All index emergency HF admissions to o+e University hospital during the year 2000 were studied.
患者: 选择2000年所有在o+e大学医院住院的急性心衰病人为研究对象.
Results: 454 consecutive index admissions had blood chemistry, diabetic status and follow-up information recorded.
结果: 454名住院患者都有连续的资料记录: 血液生化, 糖尿病情况以及随访信息.
390 (86%) patients had an echocardiogram, of whom 117 (30%) had preserved left ventricular systolic function and 110 (24%) had diabetes. Sixty (13%) patients had abnormal glucose tolerance (8.0–10.99 mmol/l), and 284 (63%) patients had a normal admission blood glucose (<8 mmol/l). 51 (11.2%) patients died in hospital.
其中的390名患者(86%)做了超声心动图检查, 这些患者中有117人(30%)左心室收缩功能正常, 110人(24%)有糖尿病. 60人(13%)糖耐量异常(8.0–10.99 mmol/l), 284人(63%)入院时血糖水平正常(<8 mmol/l). 而51名患者(11.2%)死在医院.
After adjustment for other prognostic attributes, abnormal glucose tolerance (Cox hazard ratio HR, 95% CI: 5.920, 1.03 to 34.00; p = 0.046) but not diabetes (HR 3.46, 0.75 to 16.02; p = 0.112) predicted in-hospital mortality.
在校正了其它预测因素的影响后发现糖耐量异常(Cox危险比5.920, 95%可信区间1.03 to 34.00; p = 0.046)而不是糖尿病(HR 3.46, 0.75 to 16.02; p = 0.112)能够预测住院死亡率.
During follow-up (median 812 (range 632–978) days), 104 (36.6%), 30 (50.0%) and 55 (50%) patients with a normal admission blood glucose concentration, abnormal glucose tolerance and diabetes, respectively, died (log rank test p = 0.0037, adjusted p = 0.075).
随访期间(平均812天(632-978天))发现分别有104名(36.6%)入院时血糖浓度正常的患者, 30 (50.0%)名糖耐量异常的患者和55名(50%)的糖尿病患者死亡(时序检验P=0.0037, 校正P=0.075).
Compared with patients with normal admission blood glucose, abnormal glucose tolerance (adjusted HR: 1.41 (0.92 to 2.16); p = 0.12) and diabetes (adjusted HR: 2.02 (1.41 to 2.88); p = 0.0001) predicted mortality. Considering glucose on admission as a continuous covariate, a 2 mmol/l increase was associated with a HR of 1.08 (1.03 to 1.13), p = 0.0010, which after adjustment for the above covariates became 1.08 (1.03 to 1.13), p = 0.0023.
阅读本文的人还阅读：
作者:admin@医学,生命科学 2011-02-13 05:14
医学,生命科学网