Anu Kataja1, Tuukka Tarvasmäki2, Johan Lassus3, Jose Cardoso4, Alexandre Mebazaa5, Lars Køber6, Alessandro Sionis7, Jindrich Spinar8, Valentina Carubelli9, Marek Banaszewski10, Rossella Marino11, John Parissis12, Markku S Nieminen3, Veli-Pekka Harjola2. 1. Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland. Electronic address: anu.kataja@helsinki.fi. 2. Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland. 3. Cardiology, University of Helsinki, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland. 4. CINTESIS - Center for Health Technology and Services Research, Department of Cardiology, Faculty of Medicine, University of Porto, São João Medical Center, Porto, Portugal. 5. INSERM U942, Hopital Lariboisiere, APHP and University Paris Diderot, Paris, France. 6. Rigshospitalet, Copenhagen University Hospital, Division of Heart Failure, Pulmonary Hypertension and Heart Transplantation, Copenhagen, Denmark. 7. Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat de Barcelona, Barcelona, Spain. 8. Internal Cardiology Department, University Hospital Brno and Masaryk University, Brno, Czech republic. 9. Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Brescia, Italy. 10. Intensive Cardiac Therapy Clinic, Institute of Cardiology, Warsaw, Poland. 11. Department of Medical Sciences and Translational Medicine, University of Rome Sapienza, Emergency Department, Sant''Andrea Hospital, Rome, Italy. 12. Heart Failure Clinic, Attikon University Hospital, Athens, Greece.
Abstract
BACKGROUND: Critically ill patients often present with hyperglycemia, regardless of previous history of diabetes mellitus (DM). Hyperglycemia has been associated with adverse outcome in acute myocardial infarction and acute heart failure. We investigated the association of admission blood glucose level with the clinical picture and short-term mortality in cardiogenic shock (CS). METHODS: Consecutively enrolled CS patients were divided into five categories according to plasma glucose level at the time of enrolment: hypoglycemia (glucose <4.0mmol/L), normoglycemia (4.0-7.9mmol/L), mild (8.0-11.9mmol/L), moderate (12.0-15.9mmol/L), and severe (≥16.0mmol/L) hyperglycemia. Clinical presentation, biochemistry, and short-term mortality were compared between the groups. RESULTS: Plasma glucose level of 211 CS patients was recorded. Glucose levels were distributed equally between normoglycemia (26% of patients), mild (27%), moderate (19%) and severe (25%) hyperglycemia, while hypoglycemia (2%) was rare. Severe hyperglycemia was associated with higher blood leukocyte count (17.3 (5.8) E9/L), higher lactate level (4.4 (3.3-8.4) mmol/L) and lower arterial pH (7.23 (0.14)) compared with normoglycemia or mild to moderate hyperglycemia (p<0.001 for all). In-hospital mortality was highest among hypoglycemic (60%) and severely hyperglycemic (56%) patients, compared with 22% in normoglycemic group (p<0.01). Severe hyperglycemia was an independent predictor of in-hospital mortality (OR 3.7, 95% CI 1.19-11.7, p=0.02), when adjusted for age, gender, LVEF, lactate, and DM. CONCLUSIONS: Admission blood glucose level has prognostic significance in CS. Mortality is highest among patients with severe hyperglycemia or hypoglycemia. Severe hyperglycemia is independently associated with high in-hospital mortality in CS. It is also associated with biomarkers of systemic hypoperfusion and stress response. Copyright Â
BACKGROUND:Critically illpatients often present with hyperglycemia, regardless of previous history of diabetes mellitus (DM). Hyperglycemia has been associated with adverse outcome in acute myocardial infarction and acute heart failure. We investigated the association of admission blood glucose level with the clinical picture and short-term mortality in cardiogenic shock (CS). METHODS: Consecutively enrolled CS patients were divided into five categories according to plasma glucose level at the time of enrolment: hypoglycemia (glucose <4.0mmol/L), normoglycemia (4.0-7.9mmol/L), mild (8.0-11.9mmol/L), moderate (12.0-15.9mmol/L), and severe (≥16.0mmol/L) hyperglycemia. Clinical presentation, biochemistry, and short-term mortality were compared between the groups. RESULTS: Plasma glucose level of 211 CS patients was recorded. Glucose levels were distributed equally between normoglycemia (26% of patients), mild (27%), moderate (19%) and severe (25%) hyperglycemia, while hypoglycemia (2%) was rare. Severe hyperglycemia was associated with higher blood leukocyte count (17.3 (5.8) E9/L), higher lactate level (4.4 (3.3-8.4) mmol/L) and lower arterial pH (7.23 (0.14)) compared with normoglycemia or mild to moderate hyperglycemia (p<0.001 for all). In-hospital mortality was highest among hypoglycemic (60%) and severely hyperglycemic (56%) patients, compared with 22% in normoglycemic group (p<0.01). Severe hyperglycemia was an independent predictor of in-hospital mortality (OR 3.7, 95% CI 1.19-11.7, p=0.02), when adjusted for age, gender, LVEF, lactate, and DM. CONCLUSIONS: Admission blood glucose level has prognostic significance in CS. Mortality is highest among patients with severe hyperglycemia or hypoglycemia. Severe hyperglycemia is independently associated with high in-hospital mortality in CS. It is also associated with biomarkers of systemic hypoperfusion and stress response. Copyright Â
Authors: Tien F Lee; Morton G Burt; Leonie K Heilbronn; Arduino A Mangoni; Vincent W Wong; Mark McLean; N Wah Cheung Journal: Cardiovasc Diabetol Date: 2017-12-12 Impact factor: 9.951
Authors: Sua Kim; Soo Jin Na; Taek Kyu Park; Joo Myung Lee; Young Bin Song; Jin-Oh Choi; Joo-Yong Hahn; Jin-Ho Choi; Seung-Hyuk Choi; Hyeon-Cheol Gwon; Chi Ryang Chung; Kyeongman Jeon; Gee Young Suh; Jeong Hoon Yang Journal: J Korean Med Sci Date: 2019-02-27 Impact factor: 2.153