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The glycemic gap as a prognostic indicator in cardiogenic shock: a retrospective cohort study.
- Source :
-
BMC cardiovascular disorders [BMC Cardiovasc Disord] 2024 Sep 02; Vol. 24 (1), pp. 468. Date of Electronic Publication: 2024 Sep 02. - Publication Year :
- 2024
-
Abstract
- Background: Stress-induced hyperglycemia (SIH) is associated with poor outcomes in cardiogenic shock (CS), and there have been inconsistent results among patients with or without diabetes mellitus (DM). The glycemic gap (GG) is derived by subtracting A1c-derived average glucose from blood glucose levels; it is a superior indicator of SIH. We aimed to explore the role of GG in the outcomes of patients with CS.<br />Methods: Data on patients diagnosed with CS were extracted from the MIMIC-IV v2.0 database to investigate the relationship between GG and 30-day mortality (Number of absolute GG subjects = 359; Number of relative GG subjects = 357). CS patients from the Second Affiliated Hospital of Wenzhou Medical University were enrolled to explore the correlation between GG and lactic acid (Number of absolute GG subjects = 252; Number of relative GG subjects = 251). Multivariate analysis, propensity score-matched (PSM) analysis, inverse probability treatment weighting (IPTW), and Pearson correlation analysis were applied.<br />Results: Absolute GG was associated with 30-day all-cause mortality in CS patients (HR <subscript>adjusted</subscript> : 1.779 95% CI: 1.137-2.783; HR <subscript>PSM</subscript> : 1.954 95% CI: 1.186-3.220; HR <subscript>IPTW</subscript> : 1.634 95% CI: 1.213-2.202). The higher the absolute GG level, the higher the lactic acid level (β <subscript>adjusted</subscript> : 1.448 95% CI: 0.474-2.423). A similar trend existed in relative GG (HR <subscript>adjusted</subscript> : 1.562 95% CI: 1.003-2.432; HR <subscript>PSM</subscript> : 1.790 95% CI: 1.127-2.845; HR <subscript>IPTW</subscript> : 1.740 95% CI: 1.287-2.352; β <subscript>adjusted</subscript> :1.294 95% CI: 0.369-2.219). Subgroup analysis showed that the relationship existed irrespective of DM. The area under the curve of GG combined with the Glasgow Coma Scale (GCS) for 30-day all-cause mortality was higher than that of GCS (absolute GG: 0.689 vs. 0.637; relative GG: 0.688 vs. 0.633). GG was positively related to the triglyceride-glucose index. Kaplan-Meier curves revealed that groups of higher GG with DM had the worst outcomes. The outcomes differed among races and GG levels (all P < 0.05).<br />Conclusions: Among patients with CS, absolute and relative GGs were associated with increased 30-day all-cause mortality, regardless of DM. The relationship was stable after multivariate Cox regression analysis, PSM, and IPTW analysis. Furthermore, they reflect the severity of CS to some extent. Hyperlactatemia and insulin resistance may underlie the relationship between stress-induced hyperglycemia and poor outcomes in CS patients. They both improve the predictive efficacy of the GCS.<br /> (© 2024. The Author(s).)
- Subjects :
- Humans
Male
Female
Retrospective Studies
Middle Aged
Aged
Risk Factors
Time Factors
Prognosis
China epidemiology
Databases, Factual
Predictive Value of Tests
Risk Assessment
Diabetes Mellitus blood
Diabetes Mellitus diagnosis
Diabetes Mellitus mortality
Shock, Cardiogenic mortality
Shock, Cardiogenic diagnosis
Shock, Cardiogenic blood
Shock, Cardiogenic therapy
Shock, Cardiogenic etiology
Blood Glucose metabolism
Biomarkers blood
Hyperglycemia diagnosis
Hyperglycemia mortality
Hyperglycemia blood
Glycated Hemoglobin metabolism
Lactic Acid blood
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2261
- Volume :
- 24
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC cardiovascular disorders
- Publication Type :
- Academic Journal
- Accession number :
- 39223451
- Full Text :
- https://doi.org/10.1186/s12872-024-04138-w