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

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Kataja , A , Tarvasmäki , T , Lassus , J , Cardoso , J , Mebazaa , A , Kober , L , Sionis , A , Spinar , J , Carubelli , V , Banaszewski , M , Marino , R , Parissis , J , Nieminen , M S & Harjola , V-P 2017 , ' The association of admission blood glucose level with the clinical picture and prognosis in cardiogenic shock - Results from the CardShock Study ' , International Journal of Cardiology , vol. 226 , pp. 48-52 . https://doi.org/10.1016/j.ijcard.2016.10.033

Title: The association of admission blood glucose level with the clinical picture and prognosis in cardiogenic shock - Results from the CardShock Study
Author: Kataja, Anu; Tarvasmäki, Tuukka; Lassus, Johan; Cardoso, Jose; Mebazaa, Alexandre; Kober, Lars; Sionis, Alessandro; Spinar, Jindrich; Carubelli, Valentina; Banaszewski, Marek; Marino, Rossella; Parissis, John; Nieminen, Markku S.; Harjola, Veli-Pekka
Contributor: University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, Clinicum
University of Helsinki, HUS Heart and Lung Center
University of Helsinki, Clinicum
University of Helsinki, HUS Emergency Medicine and Services
Date: 2017-01-01
Number of pages: 5
Belongs to series: International Journal of Cardiology
ISSN: 0167-5273
URI: http://hdl.handle.net/10138/231345
Abstract: 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 = 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.
Subject: Cardiogenic shock
Acute coronary syndrome
Blood glucose
Hyperglycemia
Hypoglycemia
Prognosis
CRITICALLY-ILL PATIENTS
ACUTE MYOCARDIAL-INFARCTION
STRESS HYPERGLYCEMIA
II-TRIAL
CRITICAL ILLNESS
HEART-FAILURE
MORTALITY
RISK
HYPERLACTATEMIA
HYPOGLYCEMIA
3121 Internal medicine
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