Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Eur Heart J Acute Cardiovasc Care. 2018 Aug;7(5):442-449. doi: 10.1177/2048872616684685. Epub 2017 Jan 3.
The optimal blood glucose target during the early hospitalisation of comatose survivors of out-of-hospital cardiac arrest (OHCA) has not been established.
In a retrospective cohort study, we examined clinical outcomes in relation to mean blood glucose during the first 96 hours of hospital admission in comatose survivors of OHCA with an initial shockable rhythm. Mean blood glucose was assessed as a continuous (primary analysis) and categorical variable: <6 mmol/L, 6 to <8 mmol/L and ⩾8 mmol/L. Co-primary outcomes were the rates of death during the index hospitalisation and severe neurological dysfunction at discharge. We used multivariable logistic regression analyses to adjust for baseline differences in patient and index event characteristics.
Among 122 eligible patients, death and severe neurological dysfunction occurred in 29 (24%) and 40 (33%) patients, respectively. Higher mean blood glucose levels during the first 96 hours of admission were associated with increased odds of death (odds ratio (OR): 1.50; 95% confidence interval (CI): 1.17-1.92; p = 0.001) and severe neurological dysfunction (OR: 1.42; 95% CI: 1.11-1.80; p = 0.004). The associations between mean blood glucose and the odds of death (OR: 1.35; 95% CI: 1.04-1.76; p = 0.02) and severe neurological dysfunction (OR: 1.28; 95% CI: 1.00-1.64; p = 0.05) persisted after adjusting for age, time from cardiac arrest to return of spontaneous circulation (ROSC) and vasoactive agent use. There was no interaction between age, time from cardiac arrest to ROSC or a history of diabetes mellitus and the relationship between mean blood glucose and co-primary outcomes.
In comatose survivors of OHCA with initial shockable rhythms, higher mean blood glucose levels during the first 96 hours of admission are associated with increased rates of death and severe neurological dysfunction.
在院外心脏骤停（OHCA）昏迷幸存者的早期住院期间，最佳血糖目标尚未确定。
在一项回顾性队列研究中，我们检查了初始可除颤节律的 OHCA 昏迷幸存者在入院后 96 小时内的平均血糖与临床结局之间的关系。平均血糖被评估为连续（主要分析）和分类变量：<6mmol/L、6-<8mmol/L 和 ⩾8mmol/L。主要转归是指数住院期间的死亡率和出院时严重神经功能障碍的发生率。我们使用多变量逻辑回归分析来调整患者和指数事件特征的基线差异。
在 122 名符合条件的患者中，死亡和严重神经功能障碍分别发生在 29 名（24%）和 40 名（33%）患者中。入院后前 96 小时内较高的平均血糖水平与死亡率增加（比值比（OR）：1.50；95%置信区间（CI）：1.17-1.92；p=0.001）和严重神经功能障碍（OR：1.42；95%CI：1.11-1.80；p=0.004）相关。平均血糖与死亡率（OR：1.35；95%CI：1.04-1.76；p=0.02）和严重神经功能障碍（OR：1.28；95%CI：1.00-1.64；p=0.05）的关联在调整年龄、心脏骤停至自主循环恢复（ROSC）的时间和血管活性药物使用后仍然存在。年龄、心脏骤停至 ROSC 的时间或糖尿病病史与平均血糖和主要转归之间的关系之间没有交互作用。
在初始可除颤节律的 OHCA 昏迷幸存者中，入院后前 96 小时内较高的平均血糖水平与死亡率和严重神经功能障碍的发生率增加有关。
