Mechanisms of early glucose regulation disturbance after out-of-hospital cardiopulmonary resuscitation : An explorative prospective study

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Vihonen , H , Kuisma , M , Salo , A , Ångerman , S , Pietiläinen , K & Nurmi , J 2019 , ' Mechanisms of early glucose regulation disturbance after out-of-hospital cardiopulmonary resuscitation : An explorative prospective study ' , PLoS One , vol. 14 , no. 3 , 0214209 . https://doi.org/10.1371/journal.pone.0214209

Title: Mechanisms of early glucose regulation disturbance after out-of-hospital cardiopulmonary resuscitation : An explorative prospective study
Author: Vihonen, Hanna; Kuisma, Markku; Salo, Ari; Ångerman, Susanne; Pietiläinen, Kirsi; Nurmi, Jouni
Contributor: University of Helsinki, HYKS erva
University of Helsinki, HUS Emergency Medicine and Services
University of Helsinki, HUS Emergency Medicine and Services
University of Helsinki, HUS Emergency Medicine and Services
University of Helsinki, Department of Medicine
University of Helsinki, Clinicum
Date: 2019-03-25
Language: eng
Number of pages: 13
Belongs to series: PLoS One
ISSN: 1932-6203
URI: http://hdl.handle.net/10138/301008
Abstract: Background Hyperglycemia is common and associated with increased mortality after out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC). Mechanisms behind ultra-acute hyperglycemia are not well known. We performed an explorative study to describe the changes in glucose metabolism mediators during the prehospital postresuscitation phase. Methods We included patients who were successfully resuscitated from out-of-hospital cardiac arrest in two physician-staffed units. Insulin, glucagon, and glucagon-like peptide 1 (GLP-1) were measured in prehospital and hospital admission samples. Additionally, interleukin-6 (IL-6), cortisol, and HbA1c were measured at hospital admission. Results Thirty patients participated in the study. Of those, 28 cases (71% without diabetes) had sufficient data for analysis. The median time interval between prehospital samples and hospital admission samples was 96 minutes (IQR 85-119). At the time of ROSC, the patients were hyperglycemic (11.2 mmol/l, IQR 8.8-15.7), with insulin and glucagon concentrations varying considerably, although mostly corresponding to fasting levels (10.1 mU/l, IQR 4.2-25.2 and 141 ng/l, IQR 105-240, respectively). GLP-1 increased 2- to 8-fold with elevation of IL-6. The median glucose change from prehospital to hospital admission was -2.2 mmol/l (IQR -3.6 to -0.2). No significant correlations between the change in plasma glucose levels and the changes in insulin (r = 0.30, p = 0.13), glucagon (r = 0.29, p = 0.17), or GLP-1 levels (r = 0.32, p = 0.15) or with IL-6 (r = (-0.07), p = 0.75), cortisol (r = 0.13, p = 0.52) or HbA1c levels (r = 0.34, p = 0.08) were observed. However, in patients who did not receive exogenous epinephrine during resuscitation, changes in blood glucose correlated with changes in insulin (r = 0.59, p = 0.04) and glucagon (r = 0.65, p = 0.05) levels, demonstrating that lowering glucose values was associated with a simultaneous lowering of insulin and glucagon levels. Conclusions Hyperglycemia is common immediately after OHCA and cardiopulmonary resuscitation. No clear hormonal mechanisms were observed to be linked to changes in glucose levels during the postresuscitation phase in the whole cohort. However, in patients without exogenous epinephrine treatment, the correlations between glycemic and hormonal changes were more obvious. These results call for future studies examining the mechanisms of postresuscitation hyperglycemia and the metabolic effects of the global ischemic insult and medical treatment.
Subject: GLUCAGON-LIKE PEPTIDE-1
CRITICAL ILLNESS
CARDIAC-ARREST
BLOOD-GLUCOSE
INSULIN-SECRETION
PLASMA-GLUCOSE
STRESS
INCREASE
COUNCIL
CARE
3121 General medicine, internal medicine and other clinical medicine
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