1. Kayyali, Andrea MSN, RN

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According to this study:


* In-hospital and 60-day mortality rates are higher in nondiabetic patients with elevated glucose levels on admission for heart failure.



A study of admission blood glucose levels in nondiabetic patients with heart failure found an association between higher levels and higher in-hospital and 60-day mortality rates.


Researchers identified 1,122 nondiabetic patients in the 2003 Heart Failure Survey in an Israeli database who had been admitted for treatment of either acute heart failure or exacerbation of chronic heart failure. The principal outcome measure in the study-evaluated during the hospital stay, at 60 days, at six months, and at one year-was death attributable to any cause.


The investigators stratified the patients into tertiles according to admission blood glucose level. The median value was 92 mg/dL in tertile 1 (n = 370), 113 mg/dL in tertile 2 (n = 376), and 147 mg/dL in tertile 3 (n = 376). The in-hospital mortality rate was roughly two times greater in patients in the third tertile-7.2%, compared with 4% in the first and 3% in the second. The 60-day mortality rate also was substantially higher in patients with the highest admission blood glucose levels-15.5% in the third tertile, compared with 11.4% in the first and 10.7% in the second. But there were no significant differences among patients in the three tertiles in death rates at six months or one year.


Adjusted analysis indicated that each 18 mg/dL elevation in blood glucose was associated with increased in-hospital and 60-day mortality rates of 31% and 12%, respectively. Independent predictors of death after adjustment for factors such as age, sex, and New York Heart Association (NYHA) functional class were age per decade, creatinine level on admission, systolic blood pressure of less than 115 mmHg, and NYHA functional class III or IV for in-hospital death rates and those factors plus female sex, sodium and hemoglobin levels, and heart rate for 60-day death rates.


The researchers conclude that admission blood glucose level can help clinicians identify nondiabetic patients with heart failure who may be at risk for a poorer outcome in the short term. They note that further research is needed to determine whether hyperglycemia is a marker or a cause of death in these patients.


Barsheshet A, et al. Arch Intern Med 2006;166:1,613-9.