Stress hyperglycemia leads to worse outcomes in patients with acute type A aortic dissection

"Severe SIH could be used as an independent predictor of increased risk of short-term and long-term mortality and reflect the disease severity of acute type A aortic dissection," the researchers wrote.

The study reported a greater risk of high-risk clinical manifestations and conservative treatment in patients with stress-induced hyperglycemia than in the normoglycemia group. Also, there was a higher 30-day and 1-year mortality risk in patients with severe stress-induced hyperglycemia.

Acute type A aortic dissection is one of the types of severe life-threatening cardiovascular emergencies. Previous studies have suggested stress-induced hyperglycemia to be an effective biomarker to reflect the disease severity of critically ill patients. Kefei Dou, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, and colleagues aimed to explore the prevalence of stress-induced hyperglycemia in patients with acute type A aortic dissection without diabetes and its impact on short-term and long-term clinical outcomes.

For this purpose, the researchers consecutively enrolled 1098 patients with a confirmed ATAAD diagnosis. Patients were divided in accordance to the admission blood glucose (BG) into the normoglycemia group (BG < 7.8 mmol/L), mild to moderate SIH group (7.8 ≤ BG < 11.1 mmol/L) and severe SIH group (BG ≥ 11.1 mmol/L). The association between SIH and mortality risk was determined using Multivariate regression analysis.

The study led to the following findings:

· There were 38.3% ATAAD patients with SIH, including 32.9% cases in the mild to moderate group and 5.46% cases in the severe group.

· The proportion of high-risk clinical manifestations and conservative treatment was greater in the SIH group than in the normoglycemia group.

· Severe SIH was associated with a high risk of 30-day (OR: 3.773) and 1-year mortality risk (OR: 3.522).

"Approximately 40% of the patients with ATAAD had SIH and were more likely to present with high-risk clinical features and receive non-surgical treatment," the researchers wrote.

"Severe SIH could be used as an independent predictor of increased risk of short-term and long-term mortality and reflect the disease severity of ATAAD," they concluded.

Reference:

Liu S, Song C, Cui K, Bian X, Wang H, Fu R, Zhang R, Yuan S, Dou K. Prevalence and prognostic impact of stress-induced hyperglycemia in patients with acute type A aortic dissection. Diabetes Res Clin Pract. 2023 Jul 5;203:110815. doi: 10.1016/j.diabres.2023.110815. Epub ahead of print. PMID: 37419392.