Heart and Vessels

, Volume 33, Issue 9, pp 1008–1021 | Cite as

Decreased blood glucose at admission has a prognostic impact in patients with severely decompensated acute heart failure complicated with diabetes mellitus

  • Akihiro ShirakabeEmail author
  • Noritake Hata
  • Nobuaki Kobayashi
  • Hirotake Okazaki
  • Masato Matsushita
  • Yusaku Shibata
  • Suguru Nishigoori
  • Saori Uchiyama
  • Kazutaka Kiuchi
  • Fumitaka Okajima
  • Toshiaki Otsuka
  • Kuniya Asai
  • Wataru Shimizu
Original Article


The prognostic impact of a decreased blood glucose level in acute heart failure (AHF) has not been sufficiently clarified. The data from 1234 AHF patients were examined in the present study. The blood glucose (BG) levels were evaluated at admission. The patients were divided into groups based on the following: with or without diabetes mellitus (DM), and BG level ≥ 200 mg/dl (elevated BG) or < 200 mg/dl (decreased BG). The elevated and decreased BG patients were further divided into another three groups: 200 mg/ml ≤ BG < 300 mg/dl (mild-elevated), 300 mg/ml ≤ BG < 400 mg/dl (moderate-elevated) and BG ≥ 400 mg/ml (severe-elevated); and 150 mg/ml ≤ BG < 200 mg/dl (mild-decreased), 100 mg/ml ≤ BG < 150 mg/dl (moderate-decreased) and BG < 100 mg/ml (severe-decreased), respectively. The DM patients had a significantly poorer mortality than the non-DM patients. The prognosis was different between patients with elevated or decreased BG. In DM patients with elevated BG, the severe-elevated patients had a significantly poorer prognosis than moderate- and mild-elevated patients. In the DM patients with decreased BG, the severe-decreased patients had a significantly poorer prognosis than those moderate- and mild-decreased patients. The multivariate Cox regression model showed that a severe-decreased [hazard ratio (HR) 3.245, 95% confidence interval (CI) 1.271–8.282] and severe-elevated (HR 2.300, 95% CI 1.143–4.628) status were independent predictors of 365-day mortality in AHF patients with DM. The mortality was high among AHF patients with DM. Furthermore, both severe hyperglycemia and hypoglycemia were independent predictors of the mortality in patients with AHF complicated with DM.


Acute decompensated heart failure Acute heart failure syndrome Hypoglycemia Hyperglycemia Mortality Prognosis 



We are grateful to the staff of the ICU and the medical records office at Nippon Medical School, Chiba Hokusoh Hospital, for collecting the medical data.


This research received no grants from any funding agency in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest in association with the present study.


  1. 1.
    Shirakabe A, Hata N, Kobayashi N, Shinada T, Tomita K, Tsurumi M, Matsushita M, Okazaki H, Yamamoto Y, Yokoyama S, Asai K, Mizuno K (2013) Prognostic impact of acute kidney injury in patients with acute decompensated heart failure. Circ J 77:687–696CrossRefPubMedGoogle Scholar
  2. 2.
    Okazaki H, Shirakabe A, Kobayashi N, Hata N, Shinada T, Matsushita M, Yamamoto Y, Shibuya J, Shiomura R, Nishigoori S, Asai K, Shimizu W (2016) The prognostic impact of uric acid in patients with severely decompensated acute heart failure. J Cardiol 68:384–391CrossRefPubMedGoogle Scholar
  3. 3.
    Nozaki A, Shirakabe A, Hata N, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, Nishigoori S, Uchiyama S, Kusama Y, Asai K, Shimizu W (2017) The prognostic impact of gender in patients with acute heart failure—an evaluation of the age of female patients with severely decompensated acute heart failure. J Cardiol 70:255–262CrossRefPubMedGoogle Scholar
  4. 4.
    Okazaki H, Shirakabe A, Hata N, Yamamoto M, Kobayashi N, Shinada T, Tomita K, Tsurumi M, Matsushita M, Yamamoto Y, Yokoyama S, Asai K, Shimizu W (2014) New scoring system (APACHE-HF) for predicting adverse outcomes in patients with acute heart failure: evaluation of the APACHE II and Modified APACHE II scoring systems. J Cardiol 64:441–449CrossRefPubMedGoogle Scholar
  5. 5.
    Barsheshet A, Garty M, Grossman E, Sandach A, Lewis BS, Gottlieb S, Shotan A, Behar S, Caspi A, Schwartz R, Tenenbaum A, Leor J (2006) Admission blood glucose level and mortality among hospitalized nondiabetic patients with heart failure. Arch Intern Med 166:1613–1619CrossRefPubMedGoogle Scholar
  6. 6.
    Kosiborod M, Inzucchi SE, Spertus JA, Wang Y, Masoudi FA, Havranek EP, Krumholz HM (2009) Elevated admission glucose and mortality in elderly patients hospitalized with heart failure. Circulation 119:1899–1907CrossRefPubMedGoogle Scholar
  7. 7.
    Targher G, Dauriz M, Tavazzi L, Temporelli PL, Lucci D, Urso R, Lecchi G, Bellanti G, Merlo M, Rossi A, Maggioni AP, Outcome Investigators IN-HF (2016) Prognostic impact of in-hospital hyperglycemia in hospitalized patients with acute heart failure: results of the IN-HF (Italian Network on Heart Failure) Outcome registry. Int J Cardiol 203:587–593CrossRefPubMedGoogle Scholar
  8. 8.
    Kattel S, Kasai T, Matsumoto H, Yatsu S, Murata A, Kato T, Suda S, Hiki M, Takagi A, Daida H (2017) Association between elevated blood glucose level on admission and long-term mortality in patients with acute decompensated heart failure. J Cardiol 69:619–624CrossRefPubMedGoogle Scholar
  9. 9.
    Kavanagh BP, McCowen KC (2010) Clinical practice. Glycemic control in the ICU. N Engl J Med 363:2540–2546CrossRefPubMedGoogle Scholar
  10. 10.
    NICE-SUGAR Study Investigators, Finfer S, Liu B, Chittock DR, Norton R, Myburgh JA, McArthur C, Mitchell I, Foster D, Dhingra V, Henderson WR, Ronco JJ, Bellomo R, Cook D, McDonald E, Dodek P, Hébert PC, Heyland DK, Robinson BG (2012) Hypoglycemia and risk of death in critically ill patients. N Engl J Med 367:1108–1118CrossRefGoogle Scholar
  11. 11.
    Krinsley JS, Grover A (2007) Severe hypoglycemia in critically ill patients: risk factors and outcomes. Crit Care Med 35:2262–2267CrossRefPubMedGoogle Scholar
  12. 12.
    Krinsley JS, Schultz MJ, Spronk PE, Harmsen RE, van Braam Houckgeest F, van der Sluijs JP, Mélot C, Preiser JC (2011) Mild hypoglycemia is independently associated with increased mortality in the critically ill. Crit Care 15:R173CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force Members (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200CrossRefPubMedGoogle Scholar
  14. 14.
    Miró Ò, Rossello X, Gil V, Martín-Sánchez FJ, Llorens P, Herrero-Puente P, Jacob J, Bueno H, Pocock SJ, ICA-SEMES Research Group (2017) Predicting 30-day mortality for patients with acute heart failure in the emergency department: a cohort study. Ann Intern Med 167:698–705CrossRefPubMedGoogle Scholar
  15. 15.
    Shiba N (2015) Blood urea nitrogen/creatinine ratio in acute heart failure patients. Circ J 79:1446–1447CrossRefPubMedGoogle Scholar
  16. 16.
    Murata A, Kasai T, Matsue Y, Matsumoto H, Yatsu S, Kato T, Suda S, Hiki M, Takagi A, Daida H (2018) Relationship between blood urea nitrogen-to-creatinine ratio at hospital admission and long-term mortality in patients with acute decompensated heart failure. Heart Vessels. CrossRefPubMedGoogle Scholar
  17. 17.
    Shirakabe A, Hata N, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, Nishigoori S, Uchiyama S, Asai K, Shimizu W (2018) Prognostic benefit of maintaining the hemoglobin level during the acute phase in patients with severely decompensated acute heart failure. Heart Vessels 33:264–278CrossRefPubMedGoogle Scholar
  18. 18.
    Boudina S, Abel ED (2007) Diabetic cardiomyopathy revisited. Circulation 115:3213–3223CrossRefPubMedGoogle Scholar
  19. 19.
    Aneja A, Tang WH, Bansilal S, Garcia MJ, Farkouh ME (2008) Diabetic cardiomyopathy: insights into pathogenesis, diagnostic challenges, and therapeutic options. Am J Med 121:748–757CrossRefPubMedGoogle Scholar
  20. 20.
    Shirakabe A, Zhai P, Ikeda Y, Saito T, Maejima Y, Hsu CP, Nomura M, Egashira K, Levine B, Sadoshima J (2016) Drp1-Dependent mitochondrial autophagy plays a protective role against pressure overload-induced mitochondrial dysfunction and heart failure. Circulation 133:1249–1263CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Kubli DA, Gustafsson ÅB (2015) Unbreak my heart: targeting mitochondrial autophagy in diabetic cardiomyopathy. Antioxid Redox Signal 22:1527–1544CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Xu J, Zou MH (2009) Molecular insights and therapeutic targets for diabetic endothelial dysfunction. Circulation 120:1266–1286CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kataja A, Tarvasmäki T, Lassus J, Cardoso J, Mebazaa A, Køber L, Sionis A, Spinar J, Carubelli V, Banaszewski M, Marino R, Parissis J, Nieminen MS, Harjola VP (2017) The association of admission blood glucose level with the clinical picture and prognosis in cardiogenic shock—results from the CardShock Study. Int J Cardiol. PubMedCrossRefGoogle Scholar
  24. 24.
    Spector KS (1998) Diabetic cardiomyopathy. Clin Cardiol 21:885–887CrossRefPubMedGoogle Scholar
  25. 25.
    Egi M, Bellomo R, Stachowski E, French CJ, Hart GK, Taori G, Hegarty C, Bailey M (2010) Hypoglycemia and outcome in critically ill patients. Mayo Clin Proc 85:217–224CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Lacherade JC, Jacqueminet S, Preiser JC (2009) An overview of hypoglycemia in the critically ill. J Diabetes Sci Technol 3:1242–1249CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Anfinogenova Y, Grakova EV, Shvedova M, Kopieva KV, Teplyakov AT, Popov SV (2017) Interdisciplinary approach to compensation of hypoglycemia in diabetic patients with chronic heart failure. Heart Fail Rev. CrossRefGoogle Scholar
  28. 28.
    Rana OA, Byrne CD, Greaves K (2014) Intensive glucose control and hypoglycaemia: a new cardiovascular risk factor? Heart 100:21–27CrossRefPubMedGoogle Scholar
  29. 29.
    Hemmingsen B, Lund SS, Gluud C, Vaag A, Almdal TP, Hemmingsen C, Wetterslev J (2013) Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus. Cochrane Database Syst Rev 11:CD008143Google Scholar
  30. 30.
    Yu O, Azoulay L, Yin H, Filion KB, Suissa S (2017) Sulfonylureas as initial treatment for type 2 diabetes and the risk of severe hypoglycemia. Am J Med. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Akihiro Shirakabe
    • 1
    Email author
  • Noritake Hata
    • 1
  • Nobuaki Kobayashi
    • 1
  • Hirotake Okazaki
    • 1
  • Masato Matsushita
    • 1
  • Yusaku Shibata
    • 1
  • Suguru Nishigoori
    • 1
  • Saori Uchiyama
    • 1
  • Kazutaka Kiuchi
    • 1
  • Fumitaka Okajima
    • 2
    • 6
  • Toshiaki Otsuka
    • 3
    • 4
  • Kuniya Asai
    • 5
  • Wataru Shimizu
    • 5
  1. 1.Division of Intensive Care UnitNippon Medical School Chiba Hokusoh HospitalInzaiJapan
  2. 2.Department of EndocrinologyNippon Medical School Chiba Hokusoh HospitalChibaJapan
  3. 3.Department of Hygiene and Public HealthNippon Medical SchoolTokyoJapan
  4. 4.Center for Clinical ResearchNippon Medical SchoolTokyoJapan
  5. 5.Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
  6. 6.Department of EndocrinologyDiabetes and Metabolism, Graduate School of Medicine, Nippon Medical SchoolTokyoJapan

Personalised recommendations