Erythrocyte Stress Index Promotes The Development of Type 2 Diabetes To Heart Failure: Result From Two Cohorts

Aim: To assess whether the erythrocyte stress index (ESI), a novel indicator to characterize erythrocytes, promotes the type 2 diabetes (T2D) patients developed into heart failure. Methods: Two cohorts were contained, the Medical Information Mart for Intensive Care (MIMIC) database, and the Tianjin HF with Integrated Treatment (TJHFIT). Among the 15,813 T2D patients with follow-up time (mean of 1,532 days and 959 days in the two cohorts), 3,711 finally developed HF. ESI was compared with two indicators associated with HF onset: red blood cell distribution width coefficient of variation (RDWCV) and estimated plasma volume status (ePVS). ESI was stratification with quartiles (ESIQ). The Cox analysis, restricted cubic spline (RCS), and Kaplan–Meier (KM) curves were applied. Results: The incidence of HF in T2D patients across ESI quartiles was 17%, 22%, 27%, and 29%, respectively. In MIMIC, the adjusted hazard ratios (aHR) with 95% confidence interval (CI) of ESI, RDWCV, and ePVS were 1.27 (1.20, 1.35), 1.07 (1.05, 1.10), and 1.05 (1.02, 1.07), the ESI had the highest aHR. Restricted cubic splines demonstrated that ESI, RDWCV, and ePVS exhibited an S-shaped non-linear relationship, with cut-off values of 4.19 mL/g for ESI. Kaplan-Meier curves indicated that T2D patients with ESI >4.19 mL/g had a higher probability of HF than those with ESI ≤ 4.19mL/g. Notably, ESI remained a significant predictor of HF even in T2D patients with RDWCV, and ePVS lost their predictive value. Conclusion : The ESI served as an independent prognostic marker for the development of HF in patients with T2D. Even though both RDWCV and ePVS lost their predictive value, ESI can still play its role.