Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014, Paris, France,
Intensive Care Med. 2014 Jun;40(6):855-62. doi: 10.1007/s00134-014-3269-9. Epub 2014 Mar 25.
The influence of blood glucose (BG) level during the post-resuscitation period after out-of-hospital cardiac arrest (OHCA) is still debated. To evaluate the relationship between blood glucose level and outcome, we included the median glycemia and its maximal amplitude over the first 48 h following ICU admission in an analysis of outcome predictors.
We conducted a database study in a cardiac arrest center in Paris, France. Between 2006 and 2010, we included 381 patients who were all resuscitated from an OHCA. A moderate glycemic control was applied in all patients. The median glycemia and the largest change over the first 48 h were included in a multivariate analysis that was performed to determine parameters associated with a favorable outcome.
Of the 381 patients, 136 (36 %) had a favorable outcome (CPC 1-2). Median BG level was 7.6 mmol/L (6.3-9.8) in patients with a favorable outcome compared to 9.0 mmol/L (IQR 7.1-10.6) for patients with an unfavorable outcome (p < 0.01). Median BG level variation was 7.1 (4.2-11) and 9.6 (5.9-13.6) mmol/L in patients with and without a favorable outcome, respectively (p < 0.01). In multivariate analysis, an increased median BG level over the first 48 h was found to be an independent predictor of poor issue [OR = 0.43; 95 % CI (0.24-0.78), p = 0.006]. Finally a progressive increase in median BG level was associated with a progressive increase in the proportion of patients with a poor outcome.
We observed a relationship between high blood glucose level and outcome after cardiac arrest. These results suggest the need to test a strategy combining both control of glycemia and minimization of glycemic variations for its ability to improve post-resuscitation care.
院外心脏骤停（OHCA）后复苏期间的血糖（BG）水平的影响仍存在争议。为了评估血糖水平与预后之间的关系，我们将 ICU 入院后 48 小时内的血糖中位数及其最大振幅纳入预后预测因素分析。
我们在法国巴黎的一个心脏骤停中心进行了一项数据库研究。在 2006 年至 2010 年期间，我们纳入了 381 名从 OHCA 中复苏的患者。所有患者均接受了中度血糖控制。将血糖中位数和前 48 小时内的最大变化纳入多变量分析，以确定与良好预后相关的参数。
在 381 名患者中，136 名（36%）有良好的预后（CPC 1-2）。与预后不良的患者（中位数为 9.0mmol/L，IQR 7.1-10.6）相比，预后良好的患者的 BG 水平中位数为 7.6mmol/L（6.3-9.8）（p<0.01）。在有和没有良好预后的患者中，BG 水平变化的中位数分别为 7.1（4.2-11）和 9.6（5.9-13.6）mmol/L（p<0.01）。在多变量分析中，发现前 48 小时内 BG 水平升高是预后不良的独立预测因子[OR=0.43；95%CI（0.24-0.78），p=0.006]。最后，BG 水平中位数的逐渐升高与预后不良患者比例的逐渐增加相关。
我们观察到心脏骤停后高血糖水平与预后之间存在关系。这些结果表明，需要测试一种结合血糖控制和最小化血糖波动的策略，以提高复苏后的护理。
