'Stress hyperglycemia ratio and in-hospital prognosis in non-surgical patients with heart failure and type 2 diabetes

Abstract

Objective: To evaluate the impact of stress hyperglycemia on the in-hospital prognosis in non-surgical patients with heart failure and type 2 diabetes.

Research design and methods: We identified non-surgical hospitalized patients with heart failure and type 2 diabetes from a large electronic medical record-based database of diabetes in China (WECODe) from 2011 to 2019. We estimated stress hyperglycemia using the stress hyperglycemia ratio (SHR) and its equation, say admission blood glucose/[(28.7 × HbA1c)- 46.7]. The primary outcomes included the composite cardiac events (combination of death during hospitalization, requiring cardiopulmonary resuscitation, cardiogenic shock, and the new episode of acute heart failure during hospitalization), major acute kidney injury (AKI stage 2 or 3), and major systemic infection.

Results: Of 2875 eligible Chinese adults, SHR showed U-shaped associations with composite cardiac events, major AKI, and major systemic infection. People with SHR in the third tertile (vs those with SHR in the second tertile) presented higher risks of composite cardiac events ([odds ratio, 95% confidence interval] 1.89, 1.26 to 2.87) and major AKI (1.86, 1.01 to 3.54). In patients with impaired kidney function at baseline, both SHR in the first and third tertiles anticipated higher risks of major AKI and major systemic infection.

Conclusions: Both high and low SHR indicates poor prognosis during hospitalization in non-surgical patients with heart failure and type 2 diabetes.

Keywords: Acute kidney injury; Cardiovascular events; Death; Heart failure; Hospitalization; Stress hyperglycemia; Type 2 diabetes.

Fig. 1

Correlation heatmap of baseline characteristics. ACEI angiotensin-converting enzyme inhibitor, ARB angiotensin II, receptor blockers, CCB calcium channel blocker, MRA aldosterone receptor antagonists, HbA1c glycated hemoglobin A1c, NT-proBNP, N-terminal pro-B-type natriuretic peptide, eGFR estimated glomerular filtration rate, HDL-c high-density lipoprotein, LDL-c low-density lipoprotein, ASCVD atherosclerotic cardiovascular disease, SHR stress hyperglycemia ratio, NYHA New York Heart Association. The color represents the Spearman correlation coefficient, (rs, will always take values from− 1 to 1). The brown color indicates a negative correlation, and the blue one indicates a positive correlation. The closer rs is to zero, the weaker the correlation between the two variables will be, and the lighter the color will be. The size of the square and the width of the line represent the significant level in statistics, constructed based on the transformation of Spearman`s P, − log<sub>10</sub> (Spearman`s P), with the cutoff points, − log₁₀ (0.00001), − log₁₀ (0.0001), − log₁₀ (0.001), − log₁₀ (0.01), − log₁₀ (0.05). The larger the size of the square is (the wider the line is), the smaller Spearman`s P is

Fig. 2

Nonlinear association of stress hyperglycemia ratio with primary outcomes in the total study population AKI acute kidney injury. A, Stress hyperglycemia ratio and composite of cardiac events; B, Stress hyperglycemia ratio and major acute kidney injury; C, Stress hyperglycemia ratio and major systemic infection. All analyses were adjusted for age, sex, baseline systolic blood pressure, baseline estimated glomerular filtration rate, baseline N-terminal pro-B-type natriuretic peptide, admission department (Department of Cardiology /others), Charlson Comorbidity Index, with or without ischemic heart disease at baseline, whether use of insulin at baseline (Yes vs no), and whether use of venous loop diuretics at baseline (Yes vs no).

Fig. 3

The adjusted odds ratio of stress hyperglycemia ratio tertiles for primary outcomes in the total study population, CI confidence interval, SHR stress hyperglycemia ratio. All analyses were adjusted for age, sex, baseline systolic blood pressure, baseline estimated glomerular filtration rate, baseline N-terminal pro-B-type natriuretic peptide, admission department (Dpartment of Cardiology/others), Charlson Comorbidity Index, with or without ischemic heart disease at baseline, whether use of insulin at baseline (Yes vs no), and whether use of venous loop diuretics at baseline (Yes vs no)