应激性血糖升高比值对急性心力衰竭患者预后的评估价值

Value of stress hyperglycemia ratio in predicting the prognosis of patients with acute heart failure

目的探究应激性血糖升高比值(stress hyperglycemia ratio,SHR)对急性心力衰竭(acute heart failure,AHF)患者预后的预测价值。方法回顾性纳入2016年12月至2019年1月在上海交通大学附属第六人民医院急诊科就诊的AHF患者,收集临床资料,计算SHR,SHR=入院即刻血糖(mmol/L)/[(1.59×HbA1c)-2.59]。根据患者1年内的生存情况,分为死亡组和存活组,采用Logistic回归方法分析影响患者死亡的危险因素,并根据SHR中位数分组绘制Kaplan-Meier曲线。结果共纳入符合标准的患者307例,年龄83(74,87)岁,其中男性153例。死亡组年龄、SHR及N末端B型利钠肽原(N-terminal prohormone of brain natriuretic peptide,NT-proBNP)高于存活组[84(78,88)岁vs 82(72,86)岁、1.11(0.91,1.51)vs 1.02(0.86,1.27)、5351(2098,14039)μg/L vs 4243(2294,7565)μg/L],左心室射血分数(left ventricular ejection fraction,LVEF)低于存活组[53(45,57)%vs 58(44,64)%],差异有统计学意义(P<0.05);Logistic回归分析结果提示SHR水平升高是AHF患者1年死亡的独立危险因素(OR=2.397,95%CI:1.285~4.471,P<0.05)。以SHR中位数分组绘制生存曲线,高SHR组累积生存率低,差异有统计学意义(P<0.05)。结论SHR能够识别危重的AHF患者,是AHF患者死亡的独立危险因素。

Objective To explore the value of stress hyperglycemia ratio(SHR)in predicting the prognosis of patients with acute heart failure(AHF).Methods AHF patients admitted to the Emergency Department of Shanghai Jiao Tong University Affiliated Sixth People's Hospital from December 2016 to January 2019 were retrospectively included.Clinical data were recorded and SHR was calculated.According to the survival of the patients within 1 year,they were divided into the death group(n=89)and the survival group(n=218).Logistic regression analysis was used to analyze the risk factors of mortality.Kaplan-Meier analysis was used to evaluate the correlation between SHR and the prognosis of AHF patients.Results A total of 307 patients aged 83(range 74-87)years old who met the inclusion criteria were included in this study,including 153 males and 104 females.The age,SHR and N-terminal prohormone of brain natriuretic peptide(NT-proBNP)in the death group were higher than those in the survival group[84(78,88)vs82(72,86),1.11(0.91,1.51)vs1.02(0.86,1.27),5351(2098,14039)μg/L vs 4243(2294,7565)μg/L].The left ventricular ejection fraction(LVEF)in the death group was significantly lower than that of the survival group[53(45,57)%vs 58(44,64)%,P<0.05].Logistic regression analysis showed that SHR was an independent risk factor for death in AHF patients(OR=2.397,95%CI:1.285-4.471,P<0.05).Median SHR was used to draw the survival curve.Patients with high SHR had a lower cumulative survival rate,and the difference was statistically significant(P<0.05).Conclusion SHR can identify critically ill patients and is an independent risk factor for death in AHF patients.