title: Association between elevated blood glucose and outcome in acute heart failure: results from an international observational cohort.
abstract: OBJECTIVE
  The aim of this analysis was to assess the association between elevated blood glucose level and mortality in acute heart failure (AHF).
  
  
  BACKGROUND
  Elevated blood glucose has been reported to be prognostically meaningful in patients with cardiac diagnoses, such as coronary artery disease. The short-term prognostic impact of hyperglycemia in AHF is unknown, however.
  
  
  METHODS
  In a multinational cohort of AHF, we examined the ability of blood glucose concentrations at presentation to predict all-cause mortality by 30 days. Fully adjusted models for prognosis included a previous diagnosis of diabetes mellitus as a covariate.
  
  
  RESULTS
  A total of 6,212 subjects with AHF (mean age, 72 years; 52.5% male) were studied; the median blood glucose concentration on arrival at the hospital was 7.5 mmol/l (135 mg/dl), and 41% had a previous diagnosis of diabetes mellitus (DM). After 30 days, 618 patients (10%) had died. Compared with survivors, decedents had significantly higher median blood glucose concentrations (8.9 mmol/l vs. 7.4 mmol/l; p < 0.0001). In the fully adjusted model, an elevated blood glucose level was an independent predictor of 30-day mortality in AHF (odds ratio: 2.19; 95% confidence interval: 1.69 to 2.83; p < 0.001). The risk associated with an elevated blood glucose level appeared consistent across all subgroups of patients, including patients with preserved (hazard ratio: 5.41; 95% confidence interval: 2.44 to 12.0; p < 0.0001) and impaired systolic function (hazard ratio: 2.37; 95% confidence interval: 1.57 to 3.59; p < 0.0001). Furthermore, in reclassification analyses, elevated blood glucose added significant prognostic information to clinical parameters alone (4.4% net reclassification improvement; p = 0.01).
  
  
  CONCLUSIONS
  Among patients with AHF, blood glucose concentrations at presentation are powerfully prognostic for 30-day mortality, independent of a diagnosis of diabetes mellitus or other clinical variables. Because blood glucose is easily modifiable, it may represent a valid target for therapeutic intervention.
authors: Department of Anesthesiology and Intensive Care, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France. alexandre.mebazaa@lrb.aphp.fr
authors: Alexandre
authors: A
authors: Mebazaa
authors: Etienne
authors: E
authors: Gayat
authors: Johan
authors: J
authors: Lassus
authors: Taly
authors: T
authors: Meas
authors: Christian
authors: C
authors: Mueller
authors: Aldo
authors: A
authors: Maggioni
authors: Frank
authors: F
authors: Peacock
authors: Jindrich
authors: J
authors: Spinar
authors: Veli-Pekka
authors: VP
authors: Harjola
authors: Roland
authors: R
authors: van Kimmenade
authors: Atul
authors: A
authors: Pathak
authors: Thomas
authors: T
authors: Mueller
authors: Luigi
authors: L
authors: Tavazzi
authors: Salvatore
authors: S
authors: Disomma
authors: Marco
authors: M
authors: Metra
authors: Domingo
authors: D
authors: Pascual-Figal
authors: Said
authors: S
authors: Laribi
authors: Damien
authors: D
authors: Logeart
authors: Semir
authors: S
authors: Nouira
authors: Naoki
authors: N
authors: Sato
authors: Jiri
authors: J
authors: Parenica
authors: Nicolas
authors: N
authors: Deye
authors: Riadh
authors: R
authors: Boukef
authors: Corinne
authors: C
authors: Collet
authors: Greet
authors: G
authors: Van den Berghe
authors: Alain
authors: A
authors: Cohen-Solal
authors: James L
authors: JL
authors: Januzzi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D015331:Cohort Studies; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000150:complications; D003955:Diagnostic Tests, Routine; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D016277:Ventricular Function, Left
chemical_list: D001786:Blood Glucose