J 2017

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

KATAJA, A., T. TARVASMAKI, J. LASSUS, J. CARDOSO, A. MEBAZAA et. al.

Basic information

Original name

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

Authors

KATAJA, A. (246 Finland), T. TARVASMAKI (246 Finland), J. LASSUS (246 Finland), J. CARDOSO (620 Portugal), A. MEBAZAA (250 France), L. KOBER (208 Denmark), A. SIONIS (724 Spain), Jindřich ŠPINAR (203 Czech Republic, guarantor, belonging to the institution), V. CARUBELLI (380 Italy), M. BANASZEWSKI (616 Poland), R. MARINO (380 Italy), J. PARISSIS (300 Greece), M.S. NIEMINEN (246 Finland) and V.P. HARJOLA (246 Finland)

Edition

International Journal of Cardiology, Clare (Ireland), Elsevier Ireland Ltd. 2017, 0167-5273

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 4.034

RIV identification code

RIV/00216224:14110/17:00098546

Organization unit

Faculty of Medicine

DOI

UT WoS

000390473400008

Keywords in English

Cardiogenic shock; Acute coronary syndrome; Blood glucose; Hyperglycemia; Hypoglycemia; Prognosis

Tags

Tags

International impact, Reviewed
Změněno: 21/3/2018 16:15, Soňa Böhmová

Abstract

V originále

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. (C) 2016 Elsevier Ireland Ltd. All rights reserved.