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Glucose and haemoglobin in the assessment of prognosis after first hospitalisation for heart failure
  1. J D Newton,
  2. I B Squire
  1. University of Leicester Department of Cardiovascular Sciences, Leicester Royal Infirmary, Leicester, UK
  1. Correspondence to:
    Dr Iain Squire
    University of Leicester Department of Cardiovascular Sciences, Clinical Sciences Building, Leicester Royal Infirmary, Leicester LE1 5WW, UK; is11{at}le.ac.uk

Abstract

Objective: To examine the relationship with outcome of plasma haemoglobin and glucose concentrations, measured soon after first hospital admission with chronic heart failure (CHF), in standard clinical practice.

Methods and results: Hospital records of 528 patients (43% women, mean age 70 years) with first hospital admission for CHF were reviewed. During follow up (mean 1257 days, range 520–1800), 240 (45%) patients died. On admission, 140 of 528 (27%) and at discharge 179 of 472 survivors (38%) were receiving treatment for diabetes. World Health Organization criteria for anaemia were met by 39% of men and 43% of women. Lower haemoglobin (hazard ratio 0.879, 95% confidence interval (CI) 0.828 to 0.933, p < 0.0001) and higher plasma glucose (hazard ratio 1.034, 95% CI 1.008 to 1.061, p  =  0.009) had univariate association with all-cause mortality. On multivariate analysis, compared with patients with a normal haemoglobin for their sex, hazard ratio was 1.415 (95% CI 1.087 to 1.841, p  =  0.010) for those with low haemoglobin. All-cause mortality fell linearly for haemoglobin up to 159 g/l, above which mortality increased. Glucose above the highest quartile (> 10 mmol/l) was an independent predictor of mortality (hazard ratio 1.966, 95% CI 1.376 to 2.810, p  =  0.0002). In survivors of the index admission the association between glucose and mortality was linear, the relationship being stronger for patients without diabetes.

Conclusions: Lower haemoglobin and higher plasma glucose are associated with all-cause mortality in CHF. Higher glucose is associated with mortality irrespective of diabetic status.

  • CHF, chronic heart failure
  • ELITE II, Losartan Heart Failure Survival Study
  • RENAISSANCE, Randomized Etanercept North American Strategy to Study Antagonism of Cytokines
  • WHO, World Health Organization

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Footnotes

  • Published Online First 18 April 2006

  • JDN was supported by Nuffield hospitals Leicester

  • Competing interests: None declared.

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