Background: Acute heart failure (AHF) is a severe clinical syndrome characterized as rapid onset or worsening of symptoms of chronic heart failure (CHF). Risk stratification for patients with AHF in the intensive care unit (ICU) may help clinicians to predict the 28-day mortality risk in this subpopulation and further raise the quality of care.Methods: We retrospectively reviewed and analyzed the demographic characteristics and serological indicators of patients with AHF in the Medical Information Mart for Intensive Care III (MIMIC III) (version 1.4) between June 2001 and October 2012 and our medical center between January 2019 and April 2021. The chi-squared test and the Fisher's exact test were used for comparison of qualitative variables among the AHF death group and non-death group. The clinical variables were selected by using the least absolute shrinkage and selection operator (LASSO) regression. A clinical nomogram for predicting the 28-day mortality was constructed based on the multivariate Cox proportional hazard regression analysis and further validated by the internal and external cohorts.Results: Age > 65 years [hazard ratio (HR) = 2.47], the high Sequential Organ Failure Assessment (SOFA) score (≥3 and ≤8, HR = 2.21; ≥9 and ≤20, HR = 3.29), lactic acid (Lac) (>2 mmol/l, HR = 1.40), bicarbonate (HCO3-) (>28 mmol/l, HR = 1.59), blood urea nitrogen (BUN) (>21 mg/dl, HR = 1.75), albumin (<3.5 g/dl, HR = 2.02), troponin T (TnT) (>0.04 ng/ml, HR = 4.02), and creatine kinase-MB (CK-MB) (>5 ng/ml, HR = 1.64) were the independent risk factors for predicting 28-day mortality of intensive care patients with AHF (p < 0.05). The novel nomogram was developed and validated with a promising C-index of 0.814 (95% CI: 0.754–0.882), 0.820 (95% CI: 0.721–0.897), and 0.828 (95% CI: 0.743–0.917), respectively.Conclusion: This study provides a new insight in early predicting the risk of 28-day mortality in intensive care patients with AHF. The age, the SOFA score, and serum TnT level are the leading three predictors in evaluating the short-term outcome of intensive care patients with AHF. Based on the nomogram, clinicians could better stratify patients with AHF at high risk and make adequate treatment plans.

Background: Sepsis, as one of the severe diseases, is frequently observed in critically ill patients, especially concurrent with diabetes. Whether admission blood glucose is associated with the prognosis, and outcome of septic patients is still debatable.Methods: We retrospectively reviewed and analyzed the demographic characteristics of septic patients in the Medical Information Mart for Intensive Care III (MIMIC III, version 1.4) between June 2001 and October 2012. The Chi-square and Fisher's exact tests were used for the comparison of qualitative variables among septic patients with different glucose levels and the 30-day mortality in septic patients with diabetes or not. Univariate and stepwise multivariate Cox regression analyses were used to determine the risk factors for 30-day mortality. Kaplan-Meier analysis was conducted to reveal the different 30-day survival probabilities in each subgroup.Results: A total of 2,948 septic patients (910 cases with diabetes, 2,038 cases without diabetes) were ultimately included in the study. The 30-day mortality was 32.4% (956/2,948 cases) in the overall population without any difference among diabetic and non-diabetic septic patients (p = 1.000). Admission blood glucose levels <70 mg/dl were only observed to be significantly associated with the 30-day mortality of septic patients without diabetes (hazard ratio (HR) = 2.48, p < 0.001). After adjusting for confounders, age >65 years (HR = 1.53, p = 0.001), the Sequential Organ Failure Assessment (SOFA) score >5 (HR = 2.26, p < 0.001), lactic acid >2 mmol/L (Lac, HR = 1.35, p = 0.024), and platelet abnormality (<100 k/ul: HR = 1.49; >300 k/ul: HR = 1.36, p < 0.001) were the independent risk factors for 30-day mortality in septic patients with diabetes. In non-diabetes population, age >65 years (HR = 1.53, p < 0.001), non-White or non-Black patients (HR = 1.30, p = 0.004), SOFA score >5 (HR = 1.56, p < 0.001), blood glucose <70 mg/dl (HR = 1.91, p = 0.003), anion gap (AG) >2 mmol/L (HR = 1.60, p < 0.001), Lac (HR = 1.61, p < 0.001), urea nitrogen >21 mg/dl (HR = 1.45, p = 0.001), alanine aminotransferase (ALT, HR = 1.31, p = 0.009), total bilirubin >1.2 mg/dl (HR = 1.20, p = 0.033), and low hemoglobin (HR = 1.34, p = 0.001) were the independent risk factors for 30-day mortality.Conclusions: Our results indicate admission blood glucose, especially in terms of <70 mg/dl, is the key signaling in predicting the worse 30-day survival probability of septic patients without diabetes, which could help clinicians to make a more suitable and precise treatment modality in dealing with septic patients.

Background: Studies put it there was an interaction between diabetes and abnormal blood pressure rhythm, and they both increased the morbidity and mortality of coronary artery disease (CAD). We aimed at analyzing the effects of abnormal rhythm (AR) of blood pressure (BP) and each kind of systolic or diastolic blood pressure (SBP, DBP) pattern on CAD in patients with type 2 diabetes in Southwest China.Methods: A retrospective cross-sectional study involved 853 type 2 diabetic patients with 24-hour ambulatory blood pressure monitoring divided into CAD and non-CAD groups through imaging examination of the coronary artery. SBP and DBP were divided into dipper (D), non-dipper (ND), reverse dipper (RD), and extreme dipper (ED) by nocturnal BP decline rate, respectively. The difference in mean 24-hour, daytime, bedtime SBP and DBP, and BP rhythm between groups was compared by variance analysis. The association between different BP rhythms and CAD was analyzed by multivariate logistic regression when adjust for clinical, laboratory, and BP parameters.Results: Most diabetic patients had non-dipper BP patterns in both CAD and non-CAD groups, while the CAD group had a higher percentage of RD in both SBP and DBP than non-CAD. More CAD occurred in RD-SBP than D-SBP (P<0.001), RD-SBP than ND-SBP (P<0.001), RD-DBP than D-DBP (P<0.001), and ND-DBP than D-DBP (p=0.006). AR-SBP (OR=1.622, P=0.015), AR-DBP (OR=1.774, P=0.001), RD-SBP (OR=2.320, P<0.001), RD-DBP (OR=2.140, P<0.001), ND-DBP (OR=1.648, P=0.006) were risk factors for CAD and those relationships were still significant after adjust for different parameters.Conclusion: Abnormal BP rhythm, especially reverse dipper pattern was a risk factor for CAD regardless of SBP or DBP in diabetic patients. While for non-dipper, only the non-dipper DBP pattern had a risky influence.

Background: Studies put it there was an interaction between diabetes and abnormal blood pressure rhythm, and they both increased the morbidity and mortality of coronary artery disease (CAD). We aimed at analyzing the effects of abnormal rhythm (AR) of blood pressure (BP) and each kind of systolic or diastolic blood pressure (SBP, DBP) pattern on CAD in patients with type 2 diabetes in Southwest China. Methods: A retrospective cross-sectional study involved 853 type 2 diabetic patients with 24-hour ambulatory blood pressure monitoring divided into CAD and non-CAD groups through imaging examination of the coronary artery. SBP and DBP were divided into dipper (D), non-dipper (ND), reverse dipper (RD), and extreme dipper (ED) by nocturnal BP decline rate, respectively. The difference in mean 24-hour, daytime, bedtime SBP and DBP, and BP rhythm between groups was compared by variance analysis. The association between different BP rhythms and CAD was analyzed by multivariate logistic regression when adjust for clinical, laboratory, and BP parameters.Results: Most diabetic patients had non-dipper BP patterns in both CAD and non-CAD groups, while the CAD group had a higher percentage of RD in both SBP and DBP than non-CAD. More CAD occurred in RD-SBP than D-SBP (P<0.001), RD-SBP than ND-SBP (P<0.001), RD-DBP than D-DBP (P<0.001), and ND-DBP than D-DBP (p=0.006). AR-SBP (OR=1.622, P=0.015), AR-DBP (OR=1.774, P=0.001), RD-SBP (OR=2.320, P<0.001), RD-DBP (OR=2.140, P<0.001), ND-DBP (OR=1.648, P=0.006) were risk factors for CAD and those relationships were still significant after adjust for different parameters.Conclusion: Abnormal BP rhythm, especially reverse dipper pattern was a risk factor for CAD regardless of SBP or DBP in diabetic patients. While for non-dipper, only the non-dipper DBP pattern had a risky influence.