Wu Lisha, Cao Jingjing, Ge Jiuxin
Department of Cardiovascular Medicine, Center for Cardiovascular Medicine, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, Zhejiang, P.R. China.
J Cardiothorac Surg. 2025 May 26;20(1):237. doi: 10.1186/s13019-025-03483-x.
Baseline glucose levels have been implicated in the prognosis of critically ill patients. However, the prognostic value of glucose in patients with cardiogenic shock (CS) has not been systematically evaluated. The current study aimed to provide evidence that baseline glucose levels can predict mortality in patients with CS.
PubMed, Scopus, Embase and Web of Science were searched from inception to July 31, 2024 for studies assessing mortality after CS based on different baseline glucose levels. Hyperglycemia was defined as a glucose level > 7.8-8 mmol/l. Data were synthesized using "Review Manager" (RevMan; version 5.3; The Cochrane Collaboration).
A total of nine studies were included. Meta-analysis showed that patients with CS who had baseline glucose levels > 7.8-8 mmol/l had a significantly greater risk of early mortality as compared to those with glucose levels < 7.8-8 mmol/l [risk ratio (RR), 1.48; 95% confidence interval (CI), 1.24-1.77; I-squared (I) = 65%]. Similarly, patients with CS who had baseline glucose levels > 10-11 mmol/l (RR, 1.98; 95% CI, 1.35-2.90; I = 82%) and 11.5-12mmol/l (RR, 1.43; 95% CI, 1.19-1.72; I = 74%) had significantly greater risk of early mortality as compared to those with lower levels. Severe hyperglycemia (> 16 mmol/l) was also associated with an increased risk of mortality compared with normoglycemia (RR, 1.84; 95% CI, 1.36-2.48; I = 78%).
In the present meta-analysis, the elevated risk of mortality was persistent with different glucose cut-offs, suggesting that glucose levels at admission can be useful for risk assessment in patients with CS. Further studies considering diabetes status and other important confounding factors are needed to obtain more evidence.
基线血糖水平与危重症患者的预后有关。然而，血糖在心源性休克（CS）患者中的预后价值尚未得到系统评估。本研究旨在提供证据证明基线血糖水平可预测CS患者的死亡率。
检索PubMed、Scopus、Embase和Web of Science数据库，检索时间从建库至2024年7月31日，查找基于不同基线血糖水平评估CS后死亡率的研究。高血糖定义为血糖水平>7.8 - 8 mmol/l。使用“Review Manager”（RevMan；5.3版；Cochrane协作网）进行数据合成。
共纳入9项研究。荟萃分析显示，与血糖水平<7.8 - 8 mmol/l的CS患者相比，基线血糖水平>7.8 - 8 mmol/l的患者早期死亡风险显著更高[风险比（RR），1.48；95%置信区间（CI），1.24 - 1.77；I² = 65%]。同样，与较低水平的患者相比，基线血糖水平>10 - 11 mmol/l（RR，1.98；95% CI，1.35 - 2.90；I = 82%）和11.5 - 12 mmol/l（RR，1.43；95% CI，1.19 - 1.72；I = 74%）的CS患者早期死亡风险显著更高。与血糖正常相比，严重高血糖（>16 mmol/l）也与死亡风险增加相关（RR，1.84；95% CI，1.36 - 2.48；I = 78%）。
在本荟萃分析中，不同血糖临界值下死亡率升高的风险持续存在，提示入院时的血糖水平可用于CS患者的风险评估。需要进一步考虑糖尿病状态和其他重要混杂因素的研究以获得更多证据。
