Ola Borgquist1, Matt P Wise, Niklas Nielsen, Nawaf Al-Subaie, Julius Cranshaw, Tobias Cronberg, Guy Glover, Christian Hassager, Jesper Kjaergaard, Michael Kuiper, Ondrej Smid, Andrew Walden, Hans Friberg. 1. 1Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden.2Department of Clinical Sciences, Lund University, Lund, Sweden.3Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom.4Department of Anaesthesia and Intensive Care, Intensive Care Unit, Helsingborg Hospital, Sweden.5Cardiothoracic Intensive Care Unit, St. George's Hospital NHS Foundation Trust, London, United Kingdom.6Department of Intensive Care, Royal Bournemouth Hospital, Bournemouth, United Kingdom.7Department of Neurology, Skåne University Hospital, Lund, Sweden.8Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.9Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.10Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands.11Department of Cardiology and Angiology, General University Hospital in Prague, Prague, Czech Republic.12Department of Intensive Care, Royal Berkshire Hospital, Reading, United Kingdom.
Abstract
OBJECTIVES:Dysglycemia and glycemic variability are associated with poor outcomes in critically ill patients. Targeted temperature management alters blood glucose homeostasis. We investigated the association between blood glucose concentrations and glycemic variability and the neurologic outcomes of patients randomized to targeted temperature management at 33°C or 36°C after cardiac arrest. DESIGN: Post hoc analysis of the multicenter TTM-trial. Primary outcome of this analysis was neurologic outcome after 6 months, referred to as "Cerebral Performance Category." SETTING:Thirty-six sites in Europe and Australia. PATIENTS: All 939 patients with out-of-hospital cardiac arrest of presumed cardiac cause that had been included in the TTM-trial. INTERVENTIONS: Targeted temperature management at 33°C or 36°C. MEASUREMENTS AND MAIN RESULTS: Nonparametric tests as well as multiple logistic regression and mixed effects logistic regression models were used. Median glucose concentrations on hospital admission differed significantly between Cerebral Performance Category outcomes (p < 0.0001). Hyper- and hypoglycemia were associated with poor neurologic outcome (p = 0.001 and p = 0.054). In the multiple logistic regression models, the median glycemic level was an independent predictor of poor Cerebral Performance Category (Cerebral Performance Category, 3-5) with an odds ratio (OR) of 1.13 in the adjusted model (p = 0.008; 95% CI, 1.03-1.24). It was also a predictor in the mixed model, which served as a sensitivity analysis to adjust for the multiple time points. The proportion of hyperglycemia was higher in the 33°C group compared with the 36°C group. CONCLUSION:Higher blood glucose levels at admission and during the first 36 hours, and higher glycemic variability, were associated with poor neurologic outcome and death. More patients in the 33°C treatment arm had hyperglycemia.
RCT Entities:
OBJECTIVES: Dysglycemia and glycemic variability are associated with poor outcomes in critically illpatients. Targeted temperature management alters blood glucose homeostasis. We investigated the association between blood glucose concentrations and glycemic variability and the neurologic outcomes of patients randomized to targeted temperature management at 33°C or 36°C after cardiac arrest. DESIGN: Post hoc analysis of the multicenter TTM-trial. Primary outcome of this analysis was neurologic outcome after 6 months, referred to as "Cerebral Performance Category." SETTING: Thirty-six sites in Europe and Australia. PATIENTS: All 939 patients with out-of-hospital cardiac arrest of presumed cardiac cause that had been included in the TTM-trial. INTERVENTIONS: Targeted temperature management at 33°C or 36°C. MEASUREMENTS AND MAIN RESULTS: Nonparametric tests as well as multiple logistic regression and mixed effects logistic regression models were used. Median glucose concentrations on hospital admission differed significantly between Cerebral Performance Category outcomes (p < 0.0001). Hyper- and hypoglycemia were associated with poor neurologic outcome (p = 0.001 and p = 0.054). In the multiple logistic regression models, the median glycemic level was an independent predictor of poor Cerebral Performance Category (Cerebral Performance Category, 3-5) with an odds ratio (OR) of 1.13 in the adjusted model (p = 0.008; 95% CI, 1.03-1.24). It was also a predictor in the mixed model, which served as a sensitivity analysis to adjust for the multiple time points. The proportion of hyperglycemia was higher in the 33°C group compared with the 36°C group. CONCLUSION: Higher blood glucose levels at admission and during the first 36 hours, and higher glycemic variability, were associated with poor neurologic outcome and death. More patients in the 33°C treatment arm had hyperglycemia.
Authors: Yong Hun Jung; Byung Kook Lee; Kyung Woon Jeung; Dong Hun Lee; Hyoung Youn Lee; Yong Soo Cho; Chun Song Youn; Jung Soo Park; Yong Ii Min Journal: J Clin Med Date: 2019-09-18 Impact factor: 4.241
Authors: David C Klonoff; Jordan C Messler; Guillermo E Umpierrez; Limin Peng; Robby Booth; Jennifer Crowe; Valerie Garrett; Raymie McFarland; Francisco J Pasquel Journal: Diabetes Care Date: 2020-12-15 Impact factor: 17.152