Hemodynamic Support and Cardiogenic Shock
Prognostic Impact of Plasma Glucose on Cardiogenic Shock Patients With or Without Diabetes Mellitus: Smart Rescue Trial
Seong Huan Choi1, Gwang-Seok Yoon2, Sang-Don Park2, Young-Guk Ko3, Chul-Min Ahn3, Cheol Woong Yu4, Hyun-Joong Kim5, Bum Sung Kim5, Jang-Whan Bae6, Sang Yeub Lee7, Sung Uk Kwon8, Je Sang Kim9, Jin-Ok Jeong10, Seong-Hoon Lim11, Sungsoo Cho11, Jeong Hoon Yang12, Hyeon-Cheol Gwon12
Inha University College of Medicine, Korea (Republic of)1, Inha University Hospital, Korea (Republic of)2, Severance Hospital, Korea (Republic of)3, Korea University Anam Hospital, Korea (Republic of)4, Konkuk University Medical Center, Korea (Republic of)5, Chungbuk National University Hospital, Korea (Republic of)6, Chung-Ang university Gwangmyeong hospital, Korea (Republic of)7, Inje University Ilsan Paik Hospital, Korea (Republic of)8, Dongguk University Ilsan Hospital, Korea (Republic of)9, Chungnam National University Hospital, Korea (Republic of)10, Dankook University Hospital, Korea (Republic of)11, Samsung Medical Center, Korea (Republic of)12
Even though the presence of hyperglycemia has shown to affect the clinical outcome of cardiogenic shock patients, the extent of hyperglycemia and its association with prognosis have not been fully addressed in large population.
A total of 1,177consecutive cardiogenic shock patients were enrolled from January 2014 to December of 2018 at 12 hospitals in South Korea. The primary outcome was in-hospital mortality.
Patients were divided into four groups according to their initial plasma glucose level in each of diabetes patients (n=752) and non-diabetes patients (n=425); group1(≥8 mmol/L), group 2(8-12 mmol/L), group 3(12-16mmol/L) and group4(≥16mmol/L). The groups with higher admission plasma were associated with lower systolic blood pressure, higher lactic acid level in both diabetic and non-diabetic patients. In-hospital mortality increased in groups with higher admission plasma glucose level in non-diabetic patients (group-1:24.2%, group-2:28.6%, group-3: 38.1%, group-4: 49.0%, p<0.01) whereas in diabetic patients, mortality and admission plasma glucose level showed no significant association (group-1:45%, group-2: 35.4%, group-3: 33.3%, group-4: 43.1%, p=0.26). Even after Multivariate analysis, high plasma glucose was an independent predictor of in-hospital mortality in non-diabetic patients.
In cardiogenic shock patients, higher plasma glucose obtained at admission was associated with commensurate in-hospital mortality in non-diabetic patients.