Study on the Correlation between Blood Glucose Level and Hospital Mortality in Acute Aortic Dissection Patients

Abstract

BackgroundAcute aortic dissection (AAD) is more common in critically ill patients, and hyperglycemia is an adverse factor affecting the mortality of critically ill patients.ObjectiveTo investigate the correlation between admission blood glucose level and in-hospital mortality in patients with AAD.MethodsA retrospective analysis of the case data of non-diabetic AAD patients who underwent surgical treatment at the Fourth Hospital of Hebei Medical University from January 2015 to August 2020. According to admission blood glucose level, all cases were divided into: the hyperglycemia group (>7.8 mmol/L) and the normal blood glucose group (≤7.8 mmol/L) ; Cox proportional hazard modelwas used to evaluate the correlation between admission blood glucose and in-hospital mortality in AAD patients; Kaplan-Meier method was used to analyze the survival curve; ROC analysis was conducted to evaluate the predicting values of admission blood glucose for the in-hospital mortality in AAD patients; Cox regression model were performed to determine influencing factors for in-hospital mortality in AAD patients.ResultsA total of 491 AAD patients were collected including 165 (33.6%) cases in the hyperglycemia group and 326 (66.4%) cases in the normal blood glucose group. Compared to the normal glucose group, higher in-hospital mortality was found in the hyperglycemia group (19.4% vs 10.4%, χ2=4.172, P=0.006) ; In the unadjusted Cox model, the relative risk of death in the hyperglycemia group was 1.943〔95%CI (1.199, 3.150) , P=0.007〕; After adjusting for age and sex in moderately adjusted model, it was 1.900〔95%CI (1.171, 3.082) , P=0.009〕 in the hyperglycemia group compared with the normal blood glucose group; After adjusting for age, gender, hypertension, coronary heart disease, smoking, Stanford type, systolic blood pressure and diastolic blood pressure, the risk of in-hospital death in the hyperglycemia group was 1.840〔95%CI (1.124, 3.010) , P=0.015〕. The area under the ROC curve of admission blood glucose for predicting in-hospital death of AAD patients is 0.612 (0.546, 0.696) , when the admission blood glucose cut-off value was 9.4 mmol/L, the sensitivity was 37.9% and the specificity was 84.9%, respectively. The results of multivariate Cox regression model analysis showed that Stanford type A〔HR=4.277, 95%CI (1.942, 9.420) , P<0.001〕 and blood glucose〔HR=1.864, 95%CI (1.617, 2.113) , P=0.007〕 were the influencing factors for in-hospital death in AAD patients.ConclusionThe admission blood glucose level is an influencing factor for the in-hospital mortality in AAD patients, and high blood glucose level may increase the risk of in-hospital mortality in AAD patients.

Keywords

• |aortic diseases|aneurysm, dissecting|blood glucose|blood vessel dissection|mortality|root cause analysis