The Effect Of Stress Hyperglycemia Ratio On Nosocomial Prognosis Of Patients With Acute Myocardial Infarction

Objective: Under stress,the temporary elevation of blood glucose in critically ill patients was called stress hyperglycemia(SHG).The morbidity and mortality of acute myocardial infarction(AMI)in China were extremely high,and patients with stress hyperglycemia often had worse prognosis.Current studies mostly used admission blood glucose or fasting blood glucose to reflect stress hyperglycemia.Compared with single blood glucose,stress hyperglycemia ratio(SHR)adjusted the effects of previous meals and basal glucose that reflected the relative elevation of blood glucose,which chould help us to identify the real one.This passage analyzed the occurrence of major adverse cardiovascular events(MACE)in patients with AMI during hospitalization,so as to explore whether it is an independent risk factor of nosocomial MACE in non-diabetic and diabetic patients with AMI,and to find the critical value.At the same time,compared the predictive value of stress hyperglycemia ratio and fasting blood glucose on nosocomial prognosis of patients with AMI.Methods: This is a retrospective study,there were 198 patients with AMI of our hospital were recruited due to acute chest pain during January 2018 to December 2018.There were 106 case of non-diabetic and 92 case of diabetic.There were 153 case of male and 45 case of female,and the average year-old was(63.53±12.02).There were 110 cases of acute ST-segment elevation myocardial infarction and 88 cases of non-STsegment elevation myocardial infarction.The patients were divided into non-diabetic and diabetic groups.The SHR of the two groups were calculated according to the fasting blood glucose and glycosylated hemoglobin measured within 24 hours after admission,and four groups were further divided according to the median of SHR(0.909 in the non-diabetic group and 0.950 in the diabetic group).Reviewed the case date to collecte the basic clinical information of patients(age,gender,body mass index),conditions of admission(rhythm of the heart,heart rate,systolic blood pressure,diastolic blood pressure),previous history(hypertension,diabetes,coronary heart disease,stroke),smoking history,cardiac function(ventricular wall motion,Killip grade,left ventricular ejection fraction),fasting venous blood within 24 hours after admission(fasting blood glucose,glycosylated hemoglobin,total cholesterol,triglyceride,high-density lipoprotein,low-density lipoprotein),clinical diagnosis and percutaneous coronary intervention(coronary angiogram,primary PCI,number of lesions,number of stent,no reflow).The end point was the incidence of nosocomial MACE in patients with AMI,including heart failure,non-fatal reinfarction,all-cause death and non-fatal stroke.IBM SPSS 22 statistical software was used for statistical analysis to compare the clinical data between low SHR group and high SHR group of non-diabetic and diabetic patients with AMI.The Binary Logistic regression was used to calculate odds ratio(OR)and 95% confidence interval(CI).The Medcalc software was used to analyze the subject operating characteristic(ROC)curve to compare the predictive value of SHR and fasting blood glucose.Results:1.Non-diabetic patients with acute myocardial infarction1.1 Compared with the low SHR group,the patients with high SHR had higher fasting blood glucose and lower Hb A1 c,and more patients with stress hyperglycemia.Meanwhile,the high SHR group had weaken ventricular wall motion,lower left ventricular ejection fraction.And more patients had cardiac insufficiency of Killip grade II and above(P<0.05).1.2 There were more nosocomial MACE happened in the high SHR group,and the incidence of nosocomial MACE in the high SHR group was 2.842 times higher than the low SHR group(adjusted OR=3.046,95% CI 1.048-8.855,P=0.041).Suggesting that high SHR was an independent risk factor for the incidence of nosocomial MACE in non-diabetic patients with AMI.At the same time,age≥60 was also an independent risk factor for the occurrence of nosocomial MACE(OR=3.512,95% CI 1.094-11.273,P=0.035).While male,hypertension,dyslipidemia and STEMI were not the independent risk factors for nosocomial MACE.1.3 Analyzed the ROC curves of SHR and fasting blood glucose on nosocomial MACE in non-diabetic patients.The results showed that the SHR-AUC was 0.703(95% CI 0.606-0.788,P=0.003)and the FBG-AUC was 0.704(95% CI 0.607-0.789,P=0.003),both of them have certain value in the prediction of nosocomial MACE.The critical value of SHR was 1.037,and the critical value of fasting blood glucose was 6.63mmol/L.The Medcalc software was used to compare the ROC curve of nosocomial MACE with SHR and fasting blood glucose,and there was no statistical difference in the prediction of MACE(P=0.981).2.Diabetic patients with acute myocardial infarction2.1 Compared with the low SHR group,the patients with high SHR had higher fasting blood glucose and more patients with stress hyperglycemia.Meanwhile,the high SHR group had weaken ventricular wall motion,lower left ventricular ejection fraction.And more patients had cardiac insufficiency of Killip grade II and above(P < 0.05).2.2 There were more nosocomial MACE happened in the high SHR group,and the incidence of nosocomial MACE in the high SHR group was 4.807 times higher than the low SHR group(adjusted OR=6.581,95% CI 1.945-22.266,P=0.002),which suggested that high SHR was an independent risk factor for the incidence of nosocomial MACE in diabetic patients with AMI.At the same time,age≥60 was also an independent risk factor for the occurrence of nosocomial MACE(OR=4.259,95% CI 1.031-17.593,P=0.045).While male,hypertension,dyslipidemia and STEMI were not the independent risk factors for nosocomial MACE in hospital.2.3 Analyzed the ROC curves of SHR and fasting blood glucose on nosocomial MACE in non-diabetic patients.The results showed that the SHR-AUC was 0.756(95% CI 0.656-0.840,P<0.001)and the FBG-AUC was 0.645(95% CI 0.539-0.742,P=0.033),both of them had certain value in the prediction of nosocomial MACE.The critical value of SHR was 1.117,and the critical value of fasting blood glucose was 12.03mmol/L.The Medcalc software was used to compare the ROC curve of nosocomial MACE with SHR and fasting blood glucose,SHR was better than fasting blood glucose in the prediction of nosocomial MACE(P = 0.010).Conclusions: High SHR is an independent risk factor for nosocomial MACE in patients with AMI.SHR has certain value in the prediction of nosocomial MACE,and the critical value of SHR in non-diabetic patients was 1.037,the critical value of SHR in diabetic patients was 1.117.For non-diabetic patients,SHR and fasting blood glucose had the same predictive value for the occurrence of nosocomial MACE.For diabetic patients,SHR was better than fasting blood glucose in the prediction of nosocomial MACE.SHR was better than fasting blood glucose in predicting nosocomial MACE in all patients with AMI,and it might be a new method to reflect stress hyperglycemia.