Department of Emergency Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Republic of Korea.
Department of Emergency Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Scand J Trauma Resusc Emerg Med. 2020 Sep 3;28(1):88. doi: 10.1186/s13049-020-00782-1.
To evaluate the associations between glycated hemoglobin (HbA1c) at admission and 6-month mortality and outcomes after out-of-hospital cardiac arrest (OHCA) treated by hypothermic targeted temperature management (TTM).
This single-center retrospective cohort study included adult OHCA survivors who underwent hypothermic TTM from December 2011 to December 2019. High HbA1c at admission was defined as a level higher than 6%. Poor neurological outcomes were defined as cerebral performance category scores of 3-5. The primary outcome was 6-month mortality. The secondary outcome was the 6-month neurological outcome. Descriptive statistics, log-rank tests, and multivariable regression modeling were used for data analysis.
Of the 302 patients included in the final analysis, 102 patients (33.8%) had HbA1c levels higher than 6%. The high HbA1c group had significantly worse 6-month survival (12.7% vs. 37.5%, p < 0.001) and 6-month outcomes (89.2% vs. 73.0%, p = 0.001) than the non-high HbA1c group. Kaplan-Meier analysis and the log-rank test showed that the survival time was significantly shorter in the patients with HbA1c > 6% than in those with HbA1c ≤6%. In the multivariable logistic regression analysis, HbA1c > 6% was independently associated with 6-month mortality (OR 5.85, 95% CI 2.26-15.12, p < 0.001) and poor outcomes (OR 4.18, 95% CI 1.41-12.40, p < 0.001).
This study showed that HbA1c higher than 6% at admission was associated with increased 6-month mortality and poor outcomes in OHCA survivors treated with hypothermic TTM. Poor long-term glycemic management may have prognostic significance after cardiac arrest.
评估入院时糖化血红蛋白（HbA1c）与低温目标温度管理（TTM）治疗院外心脏骤停（OHCA）后 6 个月死亡率和结局的相关性。
本单中心回顾性队列研究纳入了 2011 年 12 月至 2019 年 12 月接受低温 TTM 的成年 OHCA 幸存者。入院时高 HbA1c 定义为水平高于 6%。预后不良定义为脑功能预后评分 3-5 分。主要结局为 6 个月死亡率。次要结局为 6 个月神经结局。采用描述性统计、对数秩检验和多变量回归模型进行数据分析。
最终分析纳入 302 例患者，其中 102 例（33.8%）HbA1c 水平高于 6%。高 HbA1c 组 6 个月生存率（12.7%比 37.5%，p<0.001）和 6 个月结局（89.2%比 73.0%，p=0.001）明显更差。Kaplan-Meier 分析和对数秩检验显示，HbA1c>6%患者的生存时间明显短于 HbA1c≤6%患者。多变量 logistic 回归分析显示，HbA1c>6%与 6 个月死亡率（OR 5.85，95%CI 2.26-15.12，p<0.001）和预后不良（OR 4.18，95%CI 1.41-12.40，p<0.001）独立相关。
本研究表明，低温 TTM 治疗的 OHCA 幸存者入院时 HbA1c 高于 6%与 6 个月死亡率和预后不良增加相关。心脏骤停后血糖控制不良可能具有预后意义。
