Egger’s test results for publication bias.

Diabetes mellitus (DM) is identified as a potential modifier of clinical outcomes in acute heart failure (AHF), yet its prognostic impact is not fully determined. This systematic review and meta-analysis aimed to assess the prognostic impact of DM on survival outcomes in AHF patients by synthesizing evidence from 26 studies involving 326,928 subjects collected from Cochrane Library, PubMed, Web of Science, and Embase databases up to 1 June 2024. Both prospective/retrospective cohort and case-control studies published since 2000 were included, with outcomes evaluated through multivariate, univariate, and binary analyses using the Newcastle-Ottawa Scale for quality assessment. Multivariate analysis indicated that DM significantly increased the risk of all-cause mortality in AHF patients (cohort studies: HR = 1.21, 95%CI (1.13, 1.29), OR=1.15, 95%CI (1.05, 1.26); case-control studies: HR = 1.39, 95%CI (1.26, 1.53), OR=1.43, 95%CI (1.10, 1.84)]. Univariate analysis confirmed this finding in case-control studies [HR = 1.30, 95%CI (1.01, 1.67)], but not in cohort studies. In both cohort [RR = 1.27, 95%CI (1.12, 1.43)] and case-control [OR=1.21, 95%CI (1.08, 1.35)] studies, DM increased the risk of all-cause mortality. AHF patients with DM had a higher risk of cardiovascular mortality [cohort studies: HR = 1.85, 95%CI (1.46, 2.33); case-control: OR=1.70, 95%CI (1.17, 2.47)]. While multivariate analysis showed no association between DM and in-hospital mortality, case-control studies indicated an increased risk [OR=1.21, 95%CI (1.03, 1.42)]. DM also increased the risk of readmission [cohort studies: HR = 1.32, 95%CI (1.14, 1.53); case-control studies: HR = 1.44, 95%CI (1.23, 1.69); binary data: OR=1.19, 95%CI (1.07, 1.31)].This updated meta-analysis demonstrates that DM imposes significant adverse effects on all-cause mortality, cardiovascular-related mortality, and readmission risk in AHF patients. However, no significant connection was found between diabetes and survival outcomes with respect to the co-endpoint of death or readmission and the endpoint of in-hospital mortality. These findings underscore the necessity for implementing targeted diabetes management within AHF care protocols to enhance clinical outcomes, an essential consideration for future practice.

糖尿病（Diabetes mellitus, DM）被认为是影响急性心力衰竭（Acute Heart Failure, AHF）患者临床结局的潜在调节因素，但其对预后的影响尚未完全明确。本系统评价与Meta分析（systematic review and meta-analysis）旨在通过整合截至2024年6月1日从Cochrane图书馆、PubMed、Web of Science及Embase数据库中检索到的26项研究、共计326928名受试者的证据，评估DM对AHF患者生存结局的预后影响。本研究纳入2000年以来发表的前瞻性/回顾性队列研究及病例对照研究，采用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）进行质量评价，并通过多因素、单因素及二分类分析对结局指标进行评估。多因素分析显示，DM可显著升高AHF患者的全因死亡风险（队列研究：风险比（Hazard Ratio, HR）=1.21，95%置信区间（Confidence Interval, CI）(1.13, 1.29)；比值比（Odds Ratio, OR）=1.15，95%CI(1.05, 1.26)；病例对照研究：HR=1.39，95%CI(1.26, 1.53)，OR=1.43，95%CI(1.10, 1.84)）。单因素分析在病例对照研究中证实了这一结果[HR=1.30，95%CI(1.01, 1.67)]，但在队列研究中未观察到该关联。无论是队列研究[相对危险度（Relative Risk, RR）=1.27，95%CI(1.12, 1.43)]还是病例对照研究[OR=1.21，95%CI(1.08, 1.35)]，DM均会增加全因死亡风险。合并DM的AHF患者心血管死亡风险更高（队列研究：HR=1.85，95%CI(1.46, 2.33)；病例对照研究：OR=1.70，95%CI(1.17, 2.47)）。尽管多因素分析未显示DM与住院死亡率存在关联，但病例对照研究提示其风险升高[OR=1.21，95%CI(1.03, 1.42)]。DM还会增加再住院风险（队列研究：HR=1.32，95%CI(1.14, 1.53)；病例对照研究：HR=1.44，95%CI(1.23, 1.69)；二分类数据：OR=1.19，95%CI(1.07, 1.31)）。本更新版Meta分析表明，DM对AHF患者的全因死亡率、心血管相关死亡率及再住院风险均存在显著不良影响。然而，在死亡或再住院的复合终点以及住院死亡率终点中，未发现糖尿病与生存结局存在显著关联。本研究结果强调，在AHF诊疗方案中实施针对性的糖尿病管理以改善临床结局具有必要性，这也是未来临床实践中需重点考量的关键问题。