Glucose and haemoglobin in the assessment of prognosis after first hospitalisation for heart failure

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.