Admission blood glucose level and outcome in patients requiring venoarterial extracorporeal membrane oxygenation.
Adult
Aged
Blood Glucose
/ metabolism
Catheterization
Extracorporeal Membrane Oxygenation
/ methods
Female
Heart Arrest
/ blood
Hospitalization
Humans
Hyperglycemia
/ epidemiology
Hypoglycemia
/ epidemiology
Male
Middle Aged
Prognosis
Registries
Retrospective Studies
Shock, Cardiogenic
/ blood
Time Factors
Cardiogenic shock
ECPR
Glucose
Survival
V-A ECMO
Journal
Clinical research in cardiology : official journal of the German Cardiac Society
ISSN: 1861-0692
Titre abrégé: Clin Res Cardiol
Pays: Germany
ID NLM: 101264123
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
25
03
2021
accepted:
19
04
2021
pubmed:
5
5
2021
medline:
13
1
2022
entrez:
4
5
2021
Statut:
ppublish
Résumé
Patients with cardiogenic shock or cardiac arrest undergoing venoarterial extracorporeal membrane oxygenation (V-A ECMO) frequently present with blood glucose levels out of normal range. The clinical relevance of such findings in the context of V-A ECMO is unknown. We therefore investigated the prognostic relevance of blood glucose at time of cannulation for V-A ECMO. We conducted a single-center retrospective registry study. All patients receiving V-A ECMO from October 2010 to January 2020 were included if blood glucose level at time of cannulation were documented. Patients were divided in five groups according to the initial blood glucose level ranging from hypoglycemic (< 80 mg/dl), normoglycemic (80-140 mg/dl), to mild (141-240 mg/dl), moderate (241-400 mg/dl), and severe (> 400 mg/dl) hyperglycemia, respectively. Clinical presentation, arterial blood gas analysis, and survival were compared between the groups. 392 patients met inclusion criteria. Median age was 62 years (51.5-70.0), SAPS II at admission was 54 (43.5-63.0), and 108/392 (27.6%) were female. 131/392 were discharged alive (hospital survival 33.4%). At time of cannulation, survivors had higher pH, hemoglobin, calcium, bicarbonate but lower potassium and lactate levels compared to non-survivors (all p < 0.01). Outcome of patients diagnosed with particularly high (> 400 mg/dl) and low (< 80 mg/dl) blood glucose at time of V-A ECMO cannulation, respectively, was worse compared to patients with normoglycemic, mildly or moderately elevated values (p = 0.02). Glucose was independently associated with poor outcome after adjustment for other predictors of survival and persisted in all investigated subgroups. Arterial blood glucose at time of V-A ECMO cannulation predicts in-hospital survival of patients with cardiac shock or after ECPR. Whether dysglycemia represents a potential therapeutic target requires further evaluation in prospective studies.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with cardiogenic shock or cardiac arrest undergoing venoarterial extracorporeal membrane oxygenation (V-A ECMO) frequently present with blood glucose levels out of normal range. The clinical relevance of such findings in the context of V-A ECMO is unknown. We therefore investigated the prognostic relevance of blood glucose at time of cannulation for V-A ECMO.
METHODS
METHODS
We conducted a single-center retrospective registry study. All patients receiving V-A ECMO from October 2010 to January 2020 were included if blood glucose level at time of cannulation were documented. Patients were divided in five groups according to the initial blood glucose level ranging from hypoglycemic (< 80 mg/dl), normoglycemic (80-140 mg/dl), to mild (141-240 mg/dl), moderate (241-400 mg/dl), and severe (> 400 mg/dl) hyperglycemia, respectively. Clinical presentation, arterial blood gas analysis, and survival were compared between the groups.
RESULTS
RESULTS
392 patients met inclusion criteria. Median age was 62 years (51.5-70.0), SAPS II at admission was 54 (43.5-63.0), and 108/392 (27.6%) were female. 131/392 were discharged alive (hospital survival 33.4%). At time of cannulation, survivors had higher pH, hemoglobin, calcium, bicarbonate but lower potassium and lactate levels compared to non-survivors (all p < 0.01). Outcome of patients diagnosed with particularly high (> 400 mg/dl) and low (< 80 mg/dl) blood glucose at time of V-A ECMO cannulation, respectively, was worse compared to patients with normoglycemic, mildly or moderately elevated values (p = 0.02). Glucose was independently associated with poor outcome after adjustment for other predictors of survival and persisted in all investigated subgroups.
CONCLUSION
CONCLUSIONS
Arterial blood glucose at time of V-A ECMO cannulation predicts in-hospital survival of patients with cardiac shock or after ECPR. Whether dysglycemia represents a potential therapeutic target requires further evaluation in prospective studies.
Identifiants
pubmed: 33944987
doi: 10.1007/s00392-021-01862-7
pii: 10.1007/s00392-021-01862-7
pmc: PMC8405505
doi:
Substances chimiques
Blood Glucose
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1484-1492Informations de copyright
© 2021. The Author(s).
Références
Diabetes. 2014 May;63(5):1738-47
pubmed: 24757202
Crit Care Med. 2009 Dec;37(12):3001-9
pubmed: 19661802
Prehosp Emerg Care. 2021 Feb 2;:1-9
pubmed: 33400602
J Crit Care. 2017 Feb;37:130-135
pubmed: 27718412
Crit Care. 2017 Jun 22;21(1):157
pubmed: 28637497
Crit Care Med. 2006 Jan;34(1):96-101
pubmed: 16374162
Acta Physiol Scand. 1982 Sep;116(1):31-6
pubmed: 6760671
J Card Fail. 2012 Jun;18(6):439-45
pubmed: 22633301
Front Physiol. 2018 Nov 26;9:1669
pubmed: 30534081
Biomed Res Int. 2020 Apr 19;2020:6126534
pubmed: 32382560
N Engl J Med. 2008 Jan 10;358(2):125-39
pubmed: 18184958
Intensive Care Med. 2014 Feb;40(2):171-81
pubmed: 24420499
Resuscitation. 2020 Jan 1;146:103-110
pubmed: 31786236
Eur Heart J. 2004 Feb;25(4):308-12
pubmed: 14984919
Intensive Care Med. 2018 Dec;44(12):2312-2314
pubmed: 30430211
Eur Heart J. 2013 Oct;34(40):3102-5
pubmed: 23999451
Crit Care. 2013 Mar 06;17(2):305
pubmed: 23470218
Circulation. 2004 Nov 23;110(21):3385-97
pubmed: 15557386
Int J Cardiol. 2017 Jan 1;226:48-52
pubmed: 27788389
Resuscitation. 2009 Jun;80(6):624-30
pubmed: 19297067
BMJ. 2012 May 28;344:e3397
pubmed: 22645184
Crit Care. 2010;14(6):R224
pubmed: 21143980
Sci Rep. 2020 May 21;10(1):8423
pubmed: 32440003
N Engl J Med. 2009 Mar 26;360(13):1283-97
pubmed: 19318384
N Engl J Med. 2012 Sep 20;367(12):1108-18
pubmed: 22992074
J Crit Care. 2017 Dec;42:35-41
pubmed: 28672145
Pediatr Crit Care Med. 2015 Mar;16(3):270-5
pubmed: 25560426
Crit Care Med. 2014 Jun;42(6):1379-85
pubmed: 24561567
Lancet Diabetes Endocrinol. 2015 Sep;3(9):723-33
pubmed: 26071884
Eur Heart J Acute Cardiovasc Care. 2019 Jun;8(4):350-359
pubmed: 30003795
Am J Cardiol. 2013 Nov 1;112(9):1306-10
pubmed: 23866731
Sci Rep. 2019 Apr 18;9(1):6279
pubmed: 31000758