Blood glucose level and outcome after cardiac arrest: insights from a large registry in the hypothermia era

被引:58
作者
Daviaud, Fabrice [1 ,3 ]
Dumas, Florence [2 ,3 ,4 ]
Demars, Nadege [1 ]
Geri, Guillaume [1 ,3 ]
Bougle, Adrien [1 ,3 ]
Morichau-Beauchant, Tristan [1 ,3 ]
Yen-Lan Nguyen [1 ,3 ]
Bougouin, Wulfran [1 ,3 ]
Pene, Frederic [1 ,3 ]
Charpentier, Julien [1 ,3 ]
Cariou, Alain [1 ,3 ,4 ]
机构
[1] Cochin Univ Hosp, AP HP, Med Intens Care Unit, F-75014 Paris, France
[2] Cochin Univ Hosp, AP HP, Emergency Dept, F-75014 Paris, France
[3] Paris Descartes Univ, Paris, France
[4] INSERM, U970, Team 4, F-75015 Paris, France
关键词
Cardiac arrest; Neurologic outcome; Blood glucose; Glycemic variations; Caloric input; Insulin intake; HOSPITAL VENTRICULAR-FIBRILLATION; AMERICAN-HEART-ASSOCIATION; STRESS HYPERGLYCEMIA; CEREBRAL-ISCHEMIA; CARDIOPULMONARY-RESUSCITATION; THERAPEUTIC HYPOTHERMIA; ENHANCES APOPTOSIS; ENDOTHELIAL-CELLS; OXIDATIVE STRESS; ILL PATIENTS;
D O I
10.1007/s00134-014-3269-9
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
The influence of blood glucose (BG) level during the post-resuscitation period after out-of-hospital cardiac arrest (OHCA) is still debated. To evaluate the relationship between blood glucose level and outcome, we included the median glycemia and its maximal amplitude over the first 48 h following ICU admission in an analysis of outcome predictors. We conducted a database study in a cardiac arrest center in Paris, France. Between 2006 and 2010, we included 381 patients who were all resuscitated from an OHCA. A moderate glycemic control was applied in all patients. The median glycemia and the largest change over the first 48 h were included in a multivariate analysis that was performed to determine parameters associated with a favorable outcome. Of the 381 patients, 136 (36 %) had a favorable outcome (CPC 1-2). Median BG level was 7.6 mmol/L (6.3-9.8) in patients with a favorable outcome compared to 9.0 mmol/L (IQR 7.1-10.6) for patients with an unfavorable outcome (p < 0.01). Median BG level variation was 7.1 (4.2-11) and 9.6 (5.9-13.6) mmol/L in patients with and without a favorable outcome, respectively (p < 0.01). In multivariate analysis, an increased median BG level over the first 48 h was found to be an independent predictor of poor issue [OR = 0.43; 95 % CI (0.24-0.78), p = 0.006]. Finally a progressive increase in median BG level was associated with a progressive increase in the proportion of patients with a poor outcome. We observed a relationship between high blood glucose level and outcome after cardiac arrest. These results suggest the need to test a strategy combining both control of glycemia and minimization of glycemic variations for its ability to improve post-resuscitation care.
引用
收藏
页码:855 / 862
页数:8
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