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An elevated blood glucose level on hospital admission is associated with increased 30 and 60-day mortality in nondiabetic patients with heart failure.
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Previous reports have shown that elevated blood glucose levels are linked to increased mortality in critically ill patients, whether they have diabetes or not. Although diabetes is a known predictor of poor outcomes in heart failure patients, say the researchers, the effect of elevated blood glucose levels in the larger group of heart failure patients without diabetes is unclear.
To investigate, Dr. Jonathan Leor, from Sheba Medical Center in Tel-Hashomer, Israel, and colleagues analyzed data from 1122 nondiabetic patients who were hospitalized for heart failure.
Patients with admission blood glucose levels in the highest tertile had an in-hospital mortality rate of 7.2%, significantly higher than the 3% and 4% rates noted among patients in the lowest and middle tertiles. In addition, for each 18-mg/dL increase in the glucose level, in-hospital mortality rose by 31% and 60-day mortality by 12%.
The link between admission glucose levels and mortality remained significant even after excluding patients who had experienced an acute MI, the authors note.
By contrast, the blood glucose level was not predictive of mortality at 6 months or 1 year.
"Our finding calls attention to a new prognostic marker that could be used for early risk stratification and management of patients with heart failure at hospital admission," the researchers observe.
"It is possible," they conclude, "that better glucose control may improve prognosis in hyperglycemic patients with heart failure, as demonstrated in acute MI and critically ill patients."
Arch Intern Med 2006;166:1613-1619.
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