China: Study on Blood Glucose Fluctuation and In-Hospital Mortality

A recent study published in PLOS One has uncovered a significant association between blood glucose fluctuation and in-hospital mortality among patients experiencing acute myocardial infarction (AMI). The findings of this study provide important insights into managing blood glucose levels in AMI patients, with potential implications for improving outcomes and reducing mortality rates.

The study found a correlation between glycemic variability and in-hospital mortality, particularly among AMI patients with normal blood glucose levels at admission. The findings suggest that early intervention should be implemented to normalize high blood glucose levels at admission to AMI.

Background

Acute myocardial infarction is a fatal disease caused by acute and persistent ischemia and hypoxia of coronary arteries, leading to high morbidity and mortality rates. It is crucial to explore simple biomarkers for assessing the risk of in-hospital mortality in patients with AMI. Therefore, Nan Liang, Department of Cardiology, Xinjiang Armed Police Corps Hospital, Urumqi City, Xinjiang Province, P. R. China, and colleagues aimed to assess the relationship between glycemic variability, glucose fluctuation trajectory, and the risk of in-hospital mortality in acute myocardial infarction patients.

Study Design

For this purpose, the researchers conducted a retrospective cohort study that included AMI patients from the eICU Collaborative Research Database. In-hospital mortality of AMI patients was the primary endpoint. The three main study variables were blood glucose levels at admission, glycemic variability, and glucose fluctuation trajectory.

Admission blood glucose levels were stratified into normal, intermediate, and high. Glycemic variability was assessed using the coefficient of variation (CV) and divided into four groups based on quartiles:

• Quartile 1: CV ≤ 10
• Quartile 2: 10 < CV ≤ 30

In AMI patients, the relationship between blood glucose levels at admission, glycemic variability, glucose fluctuation trajectory, and in-hospital mortality was evaluated using univariate and multivariate Cox regression models. The study included 2590 participants.

Findings

• There was a positive relationship between high blood glucose levels at admission and in-hospital mortality [hazard ratio (HR) = 1.42].
• The fourth quartile (CV > 30) of CV was associated with increased in-hospital mortality (HR = 2.06).
• The findings indicated that only AMI individuals in the fourth quartile of glycemic variability exhibited an elevated in-hospital mortality among those with normal blood glucose levels at admission (HR = 2.33).
• Elevated blood glucose level was a risk factor for in-hospital mortality in AMI patients.

Conclusion

In conclusion, the study conducted using data from the eICU collaborative research database highlights the importance of blood glucose fluctuation as a predictor of in-hospital mortality among patients with acute myocardial infarction. The findings underscore the need for careful glycemic management in this population and suggest potential avenues for improving outcomes through targeted interventions.

Reference

Chen, J., Huang, W., & Liang, N. (2024). Blood glucose fluctuation and in-hospital mortality among patients with acute myocardial infarction: EICU collaborative research database. PLOS ONE, 19(4), e0300323. https://doi.org/10.1371/journal.pone.0300323