The role of stress hyperglycemia in acute decompensated of heart failure

BACKGROUND. The prevalence of chronic heart failure (CHF) and carbohydrate metabolism disorders (CMD) is steadily increasing in the 21st century. Currently, research into the role of stress hyperglycemia in the prognosis of patients with acute decompensated heart failure (ADHF) is relevant, given significant changes in diagnostic capabilities and drug therapy.

AIM. To determine the prognostic role of stress hyperglycemia in ADHF in patients with different carbohydrate metabolism status.

MATERIALS AND METHODS. The study included 200 patients diagnosed with ADHF. The participants were divided into 3 groups: group 1 — patients with a previously established diagnosis of CMD; group 2 — patients who had increased glucose levels during hospitalization above 6.1 mmol/L on an empty stomach and/or above 7.8 mmol/L at any time during the day, without a diagnosis of CMD; group 3 — patients without CMD in whom hyperglycemia was not recorded. A comparative analysis of clinical and anamnestic data, instrumental and laboratory parameters at the hospital stage was carried out. We assessed outcomes one year after the episode of ADHF, including rehospitalization due to ADHF after discharge and all-cause mortality.

RESULTS. Patients with stress hyperglycemia were younger than those with CMD, were more often male, and less likely to have arterial hypertension and coronary artery disease. During the first 200 days of follow-up, rehospitalization rates due to ADHF were comparable between the groups with CMD and stress hyperglycemia (p=0.18). Starting from day 200, worse outcomes were observed in the stress hyperglycemia group (p=0.03; RR 2.45, 95% CI 1.08–6.56). Patients with stress hyperglycemia more often suffered from atrial fibrillation and had lower left ventricular end-diastolic index and left ventricular end-systolic index compared with the group without CDM and normoglycemia. Patients with stress hyperglycemia were more often hospitalized with recurrent ADHF during the entire period compared with patients without CMD and registered hyperglycemia (logrank test p<0.001; RR 3.5 CI 1.9–6.5).

CONCLUSION. Stress-induced hyperglycemia in patients with ADHF is an important risk factor for worsening heart failure prognosis. Patients with hyperglycemia during ADHF require closer monitoring and control of carbohydrate metabolism indicators within one year after hospitalization.

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