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The Relationship Between the Decreased Rate of Initial Blood Glucose and Neurologic Outcomes in Survivors of Out-of-Hospital Cardiac Arrest Receiving Therapeutic Hypothermia

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Abstract

Background

Hyperglycemia in out-of-hospital cardiac arrest (OHCA) survivors is associated with poor outcomes. However, in the control of initial hyperglycemia, an adequate strategy to improve patients’ neurologic outcomes remains undetermined. Prior to the establishment of such strategy, we need to determine whether a decreased rate of initial blood glucose (BG) affects patient outcomes.

Methods

One hundred and forty-five adult non-traumatic OHCA survivors treated with therapeutic hypothermia between April 2007 and December 2011 were enrolled in this single-center retrospective cohort study. Based on the cerebral performance category (CPC) at 6 months after OHCA, study populations were categorized as “Good CPC group” (favorable outcome, CPC1 and CPC2) and “Poor CPC group” (unfavorable outcome, CPC3–CPC5). Variables related to BG were obtained, and the rate of BG change was calculated.

Results

In the Good CPC group, the time required to attain target BG levels was shorter [7.4 (2.97–18.13) vs. 13.17 (7.55–27.0) h, p < 0.001], and the average rate of glucose decrease until the attainment of target BG levels was faster [17.06 (6.67–34.49) vs. 8.33 (4.26–18.55) mg/dl/h, p = 0.005] than in the Poor CPC group. Using multivariate analysis, the faster rate (odds ratio 1.074; 95% confidence interval 1.029–1.12; p = 0.001) and the shorter time (odds ratio 13.888; 95% confidence interval 2.271–84.906; p = 0.004) required to attain target BG levels were independently related to favorable neurologic outcomes.

Conclusions

Faster rates of initial BG decrease and the shorter time required to attain target BG levels were associated with favorable neurologic outcome in survivors of OHCA receiving therapeutic hypothermia.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards”. “For this type of study formal consent is not required.”

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Correspondence to Yong Su Lim.

Electronic supplementary material

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12028_2016_353_MOESM1_ESM.tif

Supplementary Material 1 Flow chart of patient enrollment and exclusion. TH, therapeutic hypothermia; OHCA, out-of-hospital cardiac arrest; ROSC, return of spontaneous circulation; BG, blood glucose; CPC, cerebral performance category (TIFF 403 kb)

Supplementary Material 2 Relationships between other blood glucose variables and neurologic outcomes (DOCX 23 kb)

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Woo, JH., Lim, Y.S., Yang, H.J. et al. The Relationship Between the Decreased Rate of Initial Blood Glucose and Neurologic Outcomes in Survivors of Out-of-Hospital Cardiac Arrest Receiving Therapeutic Hypothermia. Neurocrit Care 26, 402–410 (2017). https://doi.org/10.1007/s12028-016-0353-8

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