title: Prognostic impact of in-hospital hyperglycemia in hospitalized patients with acute heart failure: Results of the IN-HF (Italian Network on Heart Failure) Outcome registry.
abstract: OBJECTIVE
  Although diabetes mellitus is frequently associated with heart failure (HF), the association between elevated admission glucose levels and adverse outcomes has not been well established in hospitalized patients with acute HF.
  
  
  METHODS
  We prospectively evaluated in-hospital mortality, post-discharge 1-year mortality and 1-year re-hospitalization rates in the Italian Network on Heart Failure (IN-HF) Outcome registry cohort of 1776 patients hospitalized with acute HF and stratified by their admission glucose levels (i.e., known diabetes, newly diagnosed hyperglycemia, no diabetes).
  
  
  RESULTS
  Compared with those without diabetes (n = 586), patients with either known diabetes (n = 749) (unadjusted-odds ratio [OR] 1.64, 95%CI 0.99–2.70) or newly diagnosed hyperglycemia (n = 441) (unadjusted-OR 2.34, 95%CI 1.39–3.94) had higher in-hospital mortality, but comparable post-discharge 1-year mortality rates. After adjustment for age, sex, systolic blood pressure, estimated glomerular filtration rate, left ventricular ejection fraction, HF etiology and HF worsening/de novo presentation, the results remained unchanged in patients with known diabetes (adjusted-OR 1.86, 95%CI 1.01–3.42), while achieved borderline significance in those with newly diagnosed hyperglycemia (adjusted-OR 1.81, 95%CI 0.95–3.45). One-year re-hospitalization rates were lower in patients with newly diagnosed hyperglycemia (adjusted-hazard ratio 0.74, 95%CI 0.56–0.96) than in other groups.
  
  
  CONCLUSIONS
  Elevated admission blood glucose levels are associated with poorer in-hospital survival outcomes in patients with acute HF, especially in those with previously known diabetes. This finding further highlights the importance of tight glycemic control during hospital stay and address the need of dedicated intervention studies to identify customized clinical protocols to improve in-hospital survival of these high-risk patients.
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Targher
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Dauriz
authors.affiliation: Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, RA, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.affiliation: Cardiology Division, IRCCS Fondazione Salvatore Maugeri, Veruno, NO, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Temporelli
authors.affiliation: ANMCO Research Center, Florence, Italy.
authors.forename: Donata
authors.initials: D
authors.lastname: Lucci
authors.affiliation: Department of Medicine, Surgery and Neuroscience, Pharmacology Unit "G. Segre", University of Siena, Siena, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Urso
authors.affiliation: Department of Cardiology, San Leopoldo Mandic Hospital, Merate, LC, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Lecchi
authors.affiliation: Department of Cardiology, Santa Maria delle Croci Hospital, Ravenna, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Bellanti
authors.affiliation: Cardiovascular Department, Azienda Ospedaliero-Universitaria Ospedali Riuniti, University of Trieste, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Merlo
authors.affiliation: Division of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.affiliation: ANMCO Research Center, Florence, Italy. Electronic address: centrostudi@anmco.it.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
mesh_terms: D000208:Acute Disease; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D007297:Inpatients; D007558:Italy / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D001786:Blood Glucose
keywords: Cardiac complications; Heart failure; Mortality