Zhongguo quanke yixue (Jun 2024)
Correlation between Insulin Resistance Metabolic Score and Poor Prognosis in Patients with Chronic Heart Failure
Abstract
Background Insulin resistance (IR) is closely related to the development and progression of cardiovascular disease, and several studies have now demonstrated that IR is highly prevalent in patients with heart failure (HF) and is associated with adverse cardiovascular outcomes, whereas the association between the Metabolic Score of Insulin Resistance (Mets-IR), an indicator reflecting IR, and the poor prognosis in patients with chronic heart failure (CHF) is currently unknown. Objective To analyse the correlation between Mets-IR and poor prognosis in patients with CHF. Methods This was a retrospective study, and 313 patients who were diagnosed with CHF in the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Zhengzhou University from January 2020 to January 2021 were selected as study subjects. The patients were divided into two groups according to whether all-cause mortality occurred: the all-cause mortality group (61 cases) and the control group (252 cases). Mets-IR was analysed as a categorical variable, and Mets-IR was classified into two categories by median: low level Mets-IR (Mets-IR<37.28) and high level Mets-IR (Mets-IR≥37.28). Patients' baseline data, which included Mets-IR and their age, serum biomarkers and echocardiographic indices, were collected and followed up until 2022-12-31, and patients' prognosis was collected through our electronic medical record system or telephone follow-up, with the primary endpoint event being all-cause mortality and the secondary endpoint event being readmission due to HF. Survival curves for all-cause mortality and readmission due to HF in patients with different levels of Mets-IR were analysed using Kaplan-Meier plots and Log-rank tests. Cox proportional hazards regression model was applied to analyse the correlation between Mets-IR and the risk of all-cause mortality and readmission due to HF. Receiver operating characteristic (ROC) curves were constructed to analyse the predictive value of Mets-IR for the risk of all-cause mortality and readmission due to HF in CHF patients. Results At a median follow-up of 25.0 (9.0, 28.5) months, 61 (19.5%) all-cause mortality and 121 (38.7%) readmissions due to HF occurred in 313 CHF patients. Patients in the all-cause mortality group had higher age, BMI, fasting glucose, Mets-IR, N-terminal B-type natriuretic peptide precursor, blood uric acid, neutrophil count, erythrocyte distribution width, atrial fibrillation, hypertension, diuretics, aldosterone receptor antagonist, and New York Heart Association classification than controls, and triacylglycerol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol, albumin, haemoglobin, blood sodium, left ventricular ejection fraction, and angiotensin-converting enzyme inhibitor/angiotensin receptor antagonist /angiotensin receptor-enkephalinase inhibitor were lower than those of the control group (P<0.05) .The results of the log-rank test showed that the all-cause mortality rate and the readmission rate due to HF were both higher in the patients with high-level Mets-IR than those with low-level Mets-IR (P<0.001). Cox proportional hazards regression analysis after adjusting for several confounders showed that compared with low-level Mets-IR patients, high-level Mets-IR patients had higher risks of all-cause mortality (HR=2.90, 95%CI=1.51-5.54, P=0.001) and readmission due to HF (HR=1.55, 95%CI=1.04-2.30, P=0.030). The area under the ROC curve for Mets-IR to predict the risk of all-cause mortality and the risk of readmission due to HF were 0.68 (95%CI=0.62-0.75) and 0.62 (95%CI=0.55-0.68) . Conclusion Elevated Mets-IR levels may increase the risk of all-cause mortality and readmission due to HF in patients with CHF, and can be used for risk stratification of CHF patients.
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