Taira Takuya, Inoue Akihiko, Nishimura Takeshi, Takahashi Ryo, Isobe Maho, Maemura Saki, Suga Masafumi, Ijuin Shinichi, Masano Tomoya, Matsuyama Shigenari, Ishihara Satoshi, Kuroda Yasuhiro, Nakayama Shinichi
Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe, Hyogo, 651-0073, Japan.
Faculty of Medicine, Graduate School of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita, Kagawa, 761-0793, Japan.
Clin Res Cardiol. 2023 Apr;112(4):529-538. doi: 10.1007/s00392-022-02057-4. Epub 2022 Jul 8.
Stress hyperglycemia is a normal response to stress and has been associated with outcomes in out-of-hospital cardiac arrest (OHCA) patients. However, this association remained unknown in OHCA patients receiving extracorporeal cardiopulmonary resuscitation (ECPR). This study aimed to examine the association between degree of stress hyperglycemia on admission and neurological outcomes at discharge in OHCA patients receiving ECPR.
This was a retrospective cohort study of adult OHCA patients receiving ECPR between 2011 and 2021. Patients were classified into three groups: absence of stress hyperglycemia (blood glucose level on admission < 200 mg/dL), moderate stress hyperglycemia (200-299 mg/dL), and severe stress hyperglycemia (≥ 300 mg/dL). The primary outcome was unfavorable neurological outcome (Cerebral Performance Category: 3-5) at discharge.
This study included 160 patients; unfavorable neurological outcomes totaled 79.4% (n = 127). There were 23, 52, and 85 patients in the absence, moderate, and severe stress hyperglycemia groups, respectively. Of each group, unfavorable neurological outcomes constituted 91.3%, 71.2%, and 81.2%, respectively. Multivariable analysis showed that, compared with moderate stress hyperglycemia, absence of stress hyperglycemia on admission was significantly associated with unfavorable neurological outcome at discharge (odds ratio [OR], 4.70; 95% confidence interval [CI], 1.07-33.35; p = 0.039).
Compared with moderate stress hyperglycemia on admission, absence of stress hyperglycemia showed significant association with unfavorable neurological outcome at discharge in OHCA patients receiving ECPR.
应激性高血糖是对压力的正常反应，且与院外心脏骤停（OHCA）患者的预后相关。然而，在接受体外心肺复苏（ECPR）的OHCA患者中，这种关联尚不清楚。本研究旨在探讨接受ECPR的OHCA患者入院时应激性高血糖程度与出院时神经功能预后之间的关联。
这是一项对2011年至2021年间接受ECPR的成年OHCA患者进行的回顾性队列研究。患者被分为三组：无应激性高血糖（入院时血糖水平<200mg/dL）、中度应激性高血糖（200-299mg/dL）和重度应激性高血糖（≥300mg/dL）。主要结局是出院时不良神经功能预后（脑功能分类：3-5级）。
本研究纳入160例患者；不良神经功能预后总计79.4%（n=127）。无、中度和重度应激性高血糖组分别有23、52和85例患者。每组中，不良神经功能预后分别占91.3%、71.2%和81.2%。多变量分析显示，与中度应激性高血糖相比，入院时无应激性高血糖与出院时不良神经功能预后显著相关（比值比[OR]，4.70；95%置信区间[CI]，1.07-33.35；p=0.039）。
与入院时中度应激性高血糖相比，在接受ECPR的OHCA患者中，无应激性高血糖与出院时不良神经功能预后显著相关。
