The association of admission blood glucose level with the clinical picture and prognosis in cardiogenic shock: Results from the CardShock Study

TY - JOUR

T1 - The association of admission blood glucose level with the clinical picture and prognosis in cardiogenic shock

T2 - Results from the CardShock Study

AU - Kataja, Anu

AU - Tarvasmäki, Tuukka

AU - Lassus, Johan

AU - Cardoso, Jose

AU - Mebazaa, Alexandre

AU - Køber, Lars

AU - Sionis, Alessandro

AU - Spinar, Jindrich

AU - Carubelli, Valentina

AU - Banaszewski, Marek

AU - Marino, Rossella

AU - Parissis, John

AU - Nieminen, Markku S

AU - Harjola, Veli-Pekka

N1 - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background Critically ill patients often present with hyperglycemia, regardless of previous history of diabetes mellitus (DM). Hyperglycemia has been associated with adverse outcome in acute myocardial infarction and acute heart failure. We investigated the association of admission blood glucose level with the clinical picture and short-term mortality in cardiogenic shock (CS). Methods Consecutively enrolled CS patients were divided into five categories according to plasma glucose level at the time of enrolment: hypoglycemia (glucose < 4.0 mmol/L), normoglycemia (4.0–7.9 mmol/L), mild (8.0–11.9 mmol/L), moderate (12.0–15.9 mmol/L), and severe (≥ 16.0 mmol/L) hyperglycemia. Clinical presentation, biochemistry, and short-term mortality were compared between the groups. Results Plasma glucose level of 211 CS patients was recorded. Glucose levels were distributed equally between normoglycemia (26% of patients), mild (27%), moderate (19%) and severe (25%) hyperglycemia, while hypoglycemia (2%) was rare. Severe hyperglycemia was associated with higher blood leukocyte count (17.3 (5.8) E9/L), higher lactate level (4.4 (3.3–8.4) mmol/L) and lower arterial pH (7.23 (0.14)) compared with normoglycemia or mild to moderate hyperglycemia (p < 0.001 for all). In-hospital mortality was highest among hypoglycemic (60%) and severely hyperglycemic (56%) patients, compared with 22% in normoglycemic group (p < 0.01). Severe hyperglycemia was an independent predictor of in-hospital mortality (OR 3.7, 95% CI 1.19–11.7, p = 0.02), when adjusted for age, gender, LVEF, lactate, and DM. Conclusions Admission blood glucose level has prognostic significance in CS. Mortality is highest among patients with severe hyperglycemia or hypoglycemia. Severe hyperglycemia is independently associated with high in-hospital mortality in CS. It is also associated with biomarkers of systemic hypoperfusion and stress response.

AB - Background Critically ill patients often present with hyperglycemia, regardless of previous history of diabetes mellitus (DM). Hyperglycemia has been associated with adverse outcome in acute myocardial infarction and acute heart failure. We investigated the association of admission blood glucose level with the clinical picture and short-term mortality in cardiogenic shock (CS). Methods Consecutively enrolled CS patients were divided into five categories according to plasma glucose level at the time of enrolment: hypoglycemia (glucose < 4.0 mmol/L), normoglycemia (4.0–7.9 mmol/L), mild (8.0–11.9 mmol/L), moderate (12.0–15.9 mmol/L), and severe (≥ 16.0 mmol/L) hyperglycemia. Clinical presentation, biochemistry, and short-term mortality were compared between the groups. Results Plasma glucose level of 211 CS patients was recorded. Glucose levels were distributed equally between normoglycemia (26% of patients), mild (27%), moderate (19%) and severe (25%) hyperglycemia, while hypoglycemia (2%) was rare. Severe hyperglycemia was associated with higher blood leukocyte count (17.3 (5.8) E9/L), higher lactate level (4.4 (3.3–8.4) mmol/L) and lower arterial pH (7.23 (0.14)) compared with normoglycemia or mild to moderate hyperglycemia (p < 0.001 for all). In-hospital mortality was highest among hypoglycemic (60%) and severely hyperglycemic (56%) patients, compared with 22% in normoglycemic group (p < 0.01). Severe hyperglycemia was an independent predictor of in-hospital mortality (OR 3.7, 95% CI 1.19–11.7, p = 0.02), when adjusted for age, gender, LVEF, lactate, and DM. Conclusions Admission blood glucose level has prognostic significance in CS. Mortality is highest among patients with severe hyperglycemia or hypoglycemia. Severe hyperglycemia is independently associated with high in-hospital mortality in CS. It is also associated with biomarkers of systemic hypoperfusion and stress response.

KW - Aged

KW - Blood Glucose/metabolism

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Mortality/trends

KW - Patient Admission/trends

KW - Prognosis

KW - Prospective Studies

KW - Shock, Cardiogenic/blood

U2 - 10.1016/j.ijcard.2016.10.033

DO - 10.1016/j.ijcard.2016.10.033

M3 - Journal article

C2 - 27788389

SN - 0167-5273

VL - 226

SP - 48

EP - 52

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -