Serum electrolyte/metabolite abnormalities among patients with acute myocardial infarction: comparison between patients with and without diabetes mellitus

ABSTRACT

Background: Diabetes mellitus (DM) in a setting of acute myocardial infarction (AMI) is associated with significant metabolic changes and worse outcomes.

Objective: To evaluate the prevalence and the prognostic significance of electrolyte/metabolite disturbances among AMI patients with vs. without DM.

Methods: Patients admitted to a tertiary medical center with AMI throughout 2002–2012 were screened. Exclusion criteria were: dialysis, mechanical ventilation, and in-hospital coronary artery bypass graft (CABG) surgery. All the results of the following analyses were obtained: Glucose, Uric Acid, (UA) Calcium, Magnesium, Albumin, Potassium, and Sodium. The primary outcome was in-hospital all-cause mortality.

Results: A total of 14,364 AMI patient admissions was evaluated, mean age 68.1 ± 14.4 years, 65.5% males, and 41.2% with DM. Following an adjustment to potential confounders, DM patients had increased risk for significant hyperglycemia, hyperuricemia, hypercalcemia, hypomagnesemia, hyperkalemia, and hyponatremia as well as significantly decreased risk for hypoglycemia, hypermagnesemia, and hypokalemia compared with nondiabetics. Overall, 681 (4.7%) patients died throughout the index admission. Deceased had an increased incidence of electrolyte/metabolite abnormalities versus hospital survivors. The prognostic significance of the different categories of the investigated variables is very similar among diabetics and nondiabetics, except increased and decreased uric acid levels [<4.5 (men); <4.0 (women) and ≥9.0 (men); ≥9.4 (women)] which are associated with worse outcomes among diabetics while hyperglycemia (Glucose ≥213 mg/dL) and increased Potassium levels (Potassium ≥4.4mEq/L) which comprise significantly worse prognosis among nondiabetics.

Conclusions: Patients with DM admitted with AMI are at greater risk for electrolyte/metabolite abnormalities which are associated with increased risk for in-hospital mortality. The latter association is similar among patients with and without DM except for hyperglycemia and increased potassium levels (stronger among nondiabetics).

KEYWORDS:

• Electrolyte disturbances
• diabetes mellitus
• prognosis

Authors’ contribution

AS drafted the manuscript. All authors conceived the study and participated in the design of the study coordinated and helped in obtaining all the data, YP performed the data preparation and management and analyzed the data. All authors read and approved the final manuscript.

Acknowledgments

None stated.

Data availability statement

Please contact the author for data requests.

Declaration of financial/other relationships

The authors declare that they have no competing interests.

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethics

The local ethics committees of the participating organizations and institutions approved the study, which was performed consistently with the Helsinki declaration. Receiving approval for informed consent was waived by the Helsinki committee.

Additional information

Funding

No funding was received to produce this article.