Hydration status in patients hospitalized with acute decompensated heart failure depending on the severity of glucose metabolism disorder

Abstract

Aim. To study the hydration status according to clinical parameters and laboratory and instrumental research findings at admission and discharge in patients hospitalized with acute decompensated heart failure (ADHF), depending on the severity of glucose metabolism disorder.Materials and methods. The study included 280 patients (53% men, average age 70.1 ± 10.8 years) with ADHF. 72.5% of patients had arterial hypertension in the medical history, 60% of patients had coronary artery disease. In all patients, the level of glycated hemoglobin (HbA1c) was determined to assess the glucose metabolism status. The patients were divided into groups depending on the results obtained: at HbA1c values < 5.7%, patients were included in the group without glucose metabolism disorders, at HbA1c of 5.7–6.4% – in the prediabetes group, at HbA1c ≥ 6.5% – in the type 2 diabetes group. The patients underwent a standard physical examination at admission and at discharge, as well as a clinical and comprehensive assessment of congestion (determination of N-terminal pro B-type natriuretic peptide (NT-proBNP), lung ultrasound, liver Fibroscan testing, including calculation of a controlled attenuation parameter, bioimpedance analysis of the body).Results. The frequency of glucose metabolism disorders in patients hospitalized with ADHF was 57.5% (n = 161), while prediabetes was detected in 17.1% of patients (n = 48) and type 2 diabetes – in 40.4% (n = 113) of cases. Congestion at admission was detected in all patients. A significantly higher frequency of residual (61%) and a lower frequency of subclinical congestion (10%) were revealed in patients with ADHF and type 2 diabetes, compared to patients without glucose metabolism disorders (39% for residual congestion, 27% for subclinical congestion) and prediabetes (40% for residual congestion, 25% for subclinical congestion), respectively. There were no significant differences in the frequency of euvolemia at discharge, depending on the glucose metabolism disorder.Conclusion. Тo assess congestion phenomena at discharge, it is necessary to use clinical, laboratory, and instrumental assessments for patients with ADHF and glucose metabolism disorders. However, in patients with ADHF and prediabetes, it is preferable to focus on the laboratory and instrumental assessment of congestion, while in patients with ADHF and type 2 diabetes, both clinical and laboratory and instrumental assessment of congestion should be performed.