Stress hyperglycemia and its impact on in-hospital outcomes of patients without diabetes hospitalized with acute myocardiai infarction / 中华急诊医学杂志

ABSTRACT

Objective Hyperglycemia was common during acute myocardiai infarction (AMI). This study investigated the impact of stress hyperglycemia on in-hospital outcomes in patients without diabetes hospitalized with AMI. Methods The study included 107 patients with AMI without diabetes, who were admitted to 81 hospital of PLA of Nanjing, China from January 2000 to May 2010. The in-hospital mortality and in-hospital complications were analyzed retrospectively. The exclusion criteria were (1 ) patients < 18 years old; (2) patients with history of diabetes; (3) patients who initiated anti-hyperglycemic therapy during their hospital stay though without previously diagnosed diabetes; (4) patients with non-cardiovascular causes for AMI; (5) patients with hepatic failure, kidney failure, serious lung illnesses and end stage of malignant tumour; (6) patients administrated with steroid treatment recently and those with some diseases which had dramatic effect on glucose metabolism such as hyperthyroidism and cushing syndrome. Patients were categorized according to FBG levels into4 mutually exclusive groups; <7.0 mmol/L, ≥7.0 but <8.0 mmol/L, 8.0 to< 11. 1 mmol/L and ≥11.1 mmol/L. The Statistical Package for Stata, version 9.2 was used for statistical analysis. According to corresponding data analysis of /-test, ANOVA, rank test and exact propability were used respectively. Univariate logistics regression analysis was conducted followed by multivariate logistics regression analysis on significant variables. Results The incidence rate of stress hyperglycemia in patients with AMI without diabetes was 43. 9% (n =47). In non-diabetic patients, the mortality of the group of FBG≥7. 0 mmol/L was significantly higher than the group of FBG < 7. 0 mmol/L, which are 27.66% and 6.67%(P=0.0063)respectively,OR=5.35(95%CI 1.61 - 17.75,P = 0.0061). In-hospital complications for example lung infection, congestive heart failure, serious arrhythmias and acute cerebrovas-cular events were increased significantly in AMI patients with stress hyperglycemia. Multivariate logistic regression analysis for mortality were performed adjusting for risk factors which demonstrated FBG was a independent risk factors of in-hospital death , OR = 1.56(95%CIl.09 -2.23). Conclusions In-hospital mortality and in-hospital complications were significantly increased in patients with AMI without diabetes which developed stress hyperglycemia. Stress hyperglycemia was of great prognostic value for short-outcomes of AMI.