Low stress hyperglycemia ratio predicts worse prognosis in diabetic acute heart failure patients

• Published in: Revista portuguesa de cardiologia 2023-05, Vol.42 (5), p.433-441
• Main Authors: Cunha, Filipe M., Carreira, Marta, Ferreira, Inês, Bettencourt, Paulo, Lourenço, Patrícia
• Format: Article
• Language: English
• Subjects: Acute blood glucose; Aged; Aged, 80 and over; Blood Glucose; Diabetes; Diabetes Mellitus; Glicemia aguda; Glycated Hemoglobin; Heart failure; Heart Failure - complications; Hemoglobina glicada; Humans; Hyperglycemia; Insuficiência cardíaca; Middle Aged; Prognosis; Prognóstico; Ratio de hiperglicemia de stress; Retrospective Studies; Risk Factors; Stress hyperglycemia ratio
• ISSN: 0870-2551; 2174-2030
• DOI: 10.1016/j.repc.2022.02.013

Acute blood glucose but not glycated hemoglobin (HbA1c) predicts poor outcome in acute heart failure (HF). The stress hyperglycemia ratio (SHR) has been proposed as a prognostic predictor in various clinical settings. We assessed the prognostic implications of the SHR in acute HF patients with and without diabetes. We performed a retrospective analysis of an acute HF registry conducted between 2009 and 2010. Estimated average glucose (eAG) was calculated as (28.7×HbA1c)−46.7 and SHR as acute blood glucose divided by eAG. The primary endpoint was all-cause mortality. Follow-up was three months. Patients were grouped by SHR tertiles (≤0.88, 0.89–1.16, and >1.16). Cox regression analysis was used to test the association of SHR (cut-off 0.88) with all-cause mortality. Analysis was stratified according to the presence of diabetes. Multivariate models were built accounting for acute blood glucose and for eAG (models 1 and 2, respectively). We studied 599 patients, mean age 76±12 years, of whom 62.1% had reduced ejection fraction and 50.9% had diabetes. Median acute blood glucose, eAG and SHR were 136 (107–182) mg/dl, 131 (117–151) mg/dl, and 1.02 (0.20–3.34), respectively. During follow-up 102 (17.0%) died. In patients with diabetes, those in the lowest SHR tertile had a hazard ratio (HR) of 2.24 (95% CI: 1.05–5.22) (model 1) and 2.34 (1.25–4.38) (model 2). In patients without diabetes, the HR of three-month death in the lowest SHR tertile was 0.71 (95% CI: 0.36–1.39) and 1.02 (0.58–1.81). Significant interaction was observed between diabetes and SHR. In HF patients with diabetes, a SHR ≤0.88 was associated with a more than twofold higher three-month mortality risk. No such association was found in non-diabetic patients. The presence of diabetes influences the association of the SHR with mortality. A glicemia aguda (GA), mas não a hemoglobina glicada (HbA1c), prediz pior prognóstico na insuficiência cardíaca aguda (ICA). O ratio da hiperglicemia de stress (SHR) associou-se a pior prognóstico em várias patologias. Avaliamos as implicações prognósticas do SHR em doentes com ICA com ou sem diabetes mellitus (DM). Análises retrospetiva de um registo de ICA (2009-2010). Glicemia crónica estimada (GCE)=(28,7×HbA1c)−46,7. SHR=GA/GCE. Objetivo-primário: mortalidade por qualquer causa. Seguimento: três meses. Os doentes foram agrupados de acordo com tercis de SHR (≤0,88; 0,891,16). Uma regressão de Cox foi usada para testar a associação entre SHR (ponto-de-co