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Admission Glucose Level Predicts In-hospital Mortality in Patients with Acute Pulmonary Embolism Who Were Treated with Thrombolytic Therapy

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Abstract

Background

Elevated admission serum glucose level is associated with unfavourable clinical outcomes in various clinical conditions. The aim of this study was to investigate the relationship between admission glucose levels and in-hospital and long-term adverse clinical outcomes in patients with pulmonary embolism (PE) treated with thrombolytic therapy.

Methods

A total of 183 consecutive confirmed acute PE patients (98 female and 85 male; mean age 61.9 ± 15.7 years) who were treated with thrombolytic therapy enrolled in this study. The study population was categorised into four quartiles according to admission serum glucose levels (group I: glucose ≤115 mg/dl; group II: glucose >115–141 mg/dl; group III: glucose >141–195 mg/dl; and group IV: glucose ≥196 mg/dl).

Results

In-hospital mortality was significantly higher in group IV (28.8 %) compared to group III (15.2 %), group II (6.6 %), and group I (2.1 %) (p < 0.001). In multivariate analysis, admission glucose level (OR 1.013, 95 % CI 1.004–1.021, p = 0.004) and admission anaemia (OR 0.602, 95 % CI 0.380–0.955, p = 0.03) were independent predictors of in-hospital mortality. The mean follow-up period was 34 months. During long-term follow-up, all-cause mortality, recurrent PE, major and minor bleeding were similar among the four groups.

Conclusion

Admission glucose level is a simple, inexpensive, easily available, and effective laboratory parameter for predicting in-hospital mortality in patients with PE.

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References

  1. Timóteo AT, Papoila AL, Rio P et al (2014) Prognostic impact of admission blood glucose for all-cause mortality in patients with acute coronary syndromes: added value on top of GRACE risk score. Eur Heart J Acute Cardiovasc Care 3:257–263

    Article  PubMed  Google Scholar 

  2. Ergelen M, Uyarel H, Cicek G et al (2010) Which is worst in patients undergoing primary angioplasty for acute myocardial infarction? Hyperglycaemia? Diabetes mellitus? Or both? Acta Cardiol 65:415–423

    PubMed  Google Scholar 

  3. Kolman L, Hu YC, Montgomery DG et al (2009) Prognostic value of admission fasting glucose levels in patients with acute coronary syndrome. Am J Cardiol 104:470–474

    Article  CAS  PubMed  Google Scholar 

  4. Petursson P, Herlitz J, Caidahl K et al (2007) Admission glycaemia and outcome after acute coronary syndrome. Int J Cardiol 116:315–320

    Article  CAS  PubMed  Google Scholar 

  5. Helfand BK, Maselli NJ, Lessard DM et al (2015) Elevated serum glucose levels and survival after acute heart failure: a population-based perspective. Diabetes Vasc Dis Res. 12:119–125

    Article  CAS  Google Scholar 

  6. Shimoyama T, Kimura K, Uemura J et al (2014) Elevated glucose level adversely affects infarct volume growth and neurological deterioration in non-diabetic stroke patients, but not diabetic stroke patients. Eur J Neurol 21:402–410

    Article  CAS  PubMed  Google Scholar 

  7. Ekmekci A, Cicek G, Uluganyan M et al (2014) Admission hyperglycemia predicts inhospital mortality and major adverse cardiac events after primary percutaneous coronary intervention in patients without diabetes mellitus. Angiology. 65:154–159

    Article  CAS  PubMed  Google Scholar 

  8. Kavanagh BP, McCowen KC (2010) Clinical practice. Glycemic control in the ICU. N Engl J Med 363:2540–2546

    Article  CAS  PubMed  Google Scholar 

  9. Konstantinides SV, Torbicki A, Agnelli G, Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) et al (2014) 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35:3033–3069

    Article  PubMed  Google Scholar 

  10. Bajaj N, Bozarth AL, Guillot J et al (2014) Clinical features in patients with pulmonary embolism at a community hospital: analysis of 4 years of data. J Thromb Thrombolysis 37:287–292

    Article  PubMed  Google Scholar 

  11. Sharifi M, Vajo Z, Freeman W et al (2015) Transforming and simplifying the treatment of pulmonary embolism: “safe dose” thrombolysis plus new oral anticoagulants. Lung 193:369–374

    Article  CAS  PubMed  Google Scholar 

  12. Bajaj A, Rathor P, Sehgal V et al (2015) Prognostic value of biomarkers in acute non-massive pulmonary embolism: a systematic review and meta-analysis. Lung 193:639–651

    Article  CAS  PubMed  Google Scholar 

  13. Bozbay M, Uyarel H, Avsar S et al (2015) CK-MB: a simple prognostic biomarker in patients with pulmonary embolism treated with thrombolytic therapy. J Crit Care 30:1179–1183

    Article  CAS  PubMed  Google Scholar 

  14. Lemkes BA, Hermanides J, Devries JH et al (2010) Hyperglycemia: a prothrombotic factor? J Thromb Haemost 8:1663–1669

    Article  CAS  PubMed  Google Scholar 

  15. Ageno W, Becattini C, Brighton T et al (2008) Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation 117:93–102

    Article  PubMed  Google Scholar 

  16. Oh JK, Hagler DJ, Cabalka A et al (2006) Transesophageal and intracardiac echocardiography. The echo manual, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 29–58

    Google Scholar 

  17. McMurray JJ, Adamopoulos S, Anker SD, ESC Committee for Practice Guidelines et al (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33:1787–1847

    Article  PubMed  Google Scholar 

  18. Moya A, Sutton R, Ammirati F, Task Force for the Diagnosis and Management of Syncope; European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA); Heart Failure Association (HFA); Heart Rhythm Society (HRS) et al (2009) Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 30:2631–2671

    Article  PubMed  PubMed Central  Google Scholar 

  19. Parsons MW, Barber PA, Desmond PM et al (2002) Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Ann Neurol. 52:20–28

    Article  PubMed  Google Scholar 

  20. Bruno A, Levine SR, Frankel MR et al (2002) Admission glucose level and clinical outcomes in the NINDS rt-PA stroke trial. Neurology 59:669–674

    Article  CAS  PubMed  Google Scholar 

  21. Poppe AY, Majumdar SR, Jeerakathil T et al (2009) Admission hyperglycemia predicts a worse outcome in stroke patients treated with intravenous thrombolysis. Diabetes Care 32:617–622

    Article  PubMed  PubMed Central  Google Scholar 

  22. Dungan KM, Braithwaite SS, Preiser JC (2009) Stress hyperglycaemia. Lancet 373:1798–1807

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Ceriello A, Giugliano D, Quatraro A et al (1988) Blood glucose may condition factor VII levels in diabetic and normal subjects. Diabetologia 31:889–891

    Article  CAS  PubMed  Google Scholar 

  24. Vaidyula VR, Rao AK, Mozzoli M et al (2006) Effects of hyperglycemia and hyperinsulinemia on circulating tissue factor procoagulant activity and platelet CD40 ligand. Diabetes 55:202–208

    Article  CAS  PubMed  Google Scholar 

  25. Vink H, Constantinescu AA, Spaan JA (2000) Oxidized lipoproteins degrade the endothelial surface layer: implications for platelet-endothelial cell adhesion. Circulation 101:1500–1502

    Article  CAS  PubMed  Google Scholar 

  26. Mraovic B, Hipszer BR, Epstein RH et al (2010) Preadmission hyperglycemia is an independent risk factor for in-hospital symptomatic pulmonary embolism after major orthopedic surgery. J Arthroplast 25:64–70

    Article  Google Scholar 

  27. Hermanides J, Cohn DM, Devries JH et al (2009) Venous thrombosis is associated with hyperglycemia at diagnosis: a case-control study. J Thromb Haemost 7:945–949

    Article  CAS  PubMed  Google Scholar 

  28. Scherz N, Labarère J, Aujesky D et al (2012) Elevated admission glucose and mortality in patients with acute pulmonary embolism. Diabetes Care 35:25–31

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Tıbbiye Caddesi No: 13 Kadikoy, 34668, Istanbul, Turkey

    Mehmet Bozbay, Sahin Avsar, Ahmet Oz, Muhammed Keskin, Ahmet Murat, Adnan Kaya, Murat Ugur & Mehmet Eren

  2. Department of Cardiology, School of Medicine, Bezm-i Alem Vakif University, Istanbul, Turkey

    Huseyin Uyarel

  3. Department of Cardiology, School of Medicine, Marmara University, Istanbul, Turkey

    Halil Atas & Ahmet Altug Cincin

Authors
  1. Mehmet Bozbay
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  2. Huseyin Uyarel
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  3. Sahin Avsar
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  4. Ahmet Oz
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  5. Muhammed Keskin
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  6. Ahmet Murat
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  7. Adnan Kaya
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  8. Halil Atas
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  9. Ahmet Altug Cincin
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  10. Murat Ugur
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  11. Mehmet Eren
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Correspondence to Mehmet Bozbay.

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Bozbay, M., Uyarel, H., Avsar, S. et al. Admission Glucose Level Predicts In-hospital Mortality in Patients with Acute Pulmonary Embolism Who Were Treated with Thrombolytic Therapy. Lung 194, 219–226 (2016). https://doi.org/10.1007/s00408-016-9858-3

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  • DOI: https://doi.org/10.1007/s00408-016-9858-3

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