Associations between intra-arrest blood glucose level and outcomes of adult in-hospital cardiac arrest: A 10-year retrospective cohort study
Journal
Resuscitation
Journal Volume
146
Pages
103-110
Date Issued
2020
Author(s)
Chou E.
Yu P.-H.
Abstract
Aim: We attempted to examine the association between intra-arrest blood glucose (BG) level and outcomes of in-hospital cardiac arrest (IHCA). The interaction between diabetes mellitus (DM) and BG level as well as between dextrose administration and BG level were investigated. Methods: This single-centred retrospective study reviewed IHCA patients between 2006 and 2015. Patients with measured intra-arrest BG levels were included. Multivariable logistic regression analyses were conducted. Generalised additive models were used to identify appropriate cut-off points for continuous variables. Interactions between independent variables were assessed during the model-fitting process. Results: Among the 580 included patients, 34 (5.9%) achieved neurologically intact survival. There were 197 DM patients (34.0%). The mean intra-arrest BG level was 191.5 mg/dl, with 57 patients (9.8%) experiencing hypoglycaemia (BG level ? 70 mg/dl). A total of 165 patients (28.4%) received a dextrose injection. An intra-arrest BG level ? 150 mg/dl was inversely associated with favourable neurological outcomes at hospital discharge (odds ratio [OR]: 0.28, 95% confidence interval [CI]: 0.11–0.73; p-value = 0.01). In analyses of interactions, non-DM × BG level ? 168 mg/dl was inversely associated with favourable neurological outcomes (OR: 0.30, 95% CI: 0.11–0.80; p-value = 0.02). There were no significant interactions between BG level and dextrose administration. Conclusion: IHCA patients with intra-arrest BG level ? 150 mg/dl had worse neurological recovery. Intra-arrest hypoglycaemia might be a marker of critical illness. Dextrose administration was not shown to improve outcomes of IHCA patients with intra-arrest BG level ? 150 mg/dl, indicating the need to develop new therapeutics other than dextrose administration for these patients. ? 2019 Elsevier B.V.
SDGs
Other Subjects
glucose; biological marker; glucose; sweetening agent; adult; aged; Article; clinical outcome; critical illness; female; glucose blood level; heart arrest; hospital discharge; human; hypoglycemia; major clinical study; male; middle aged; priority journal; retrospective study; survival; blood; critical illness; diabetes mellitus; glucose blood level; heart arrest; hospital mortality; hospitalization; hypoglycemia; mortality; neuroprotection; procedures; resuscitation; Taiwan; Biomarkers; Blood Glucose; Cardiopulmonary Resuscitation; Critical Illness; Diabetes Mellitus; Female; Glucose; Heart Arrest; Hospital Mortality; Hospitalization; Humans; Hypoglycemia; Male; Middle Aged; Neuroprotection; Outcome and Process Assessment, Health Care; Sweetening Agents; Taiwan
Type
journal article