Abstract
Purpose
A recent study showed that increased blood glucose variability was an independent
predictor of mortality in cardiac arrest survivors treated with therapeutic hypothermia
(TH). We hypothesized that the association of blood glucose variability with outcomes
would differ depending on the TH phase, as body temperature affects glucose homeostasis.
Methods
A retrospective cohort of 147 consecutive cardiac arrest patients treated with TH
was analyzed. Mean absolute glucose change (MAGC) was calculated using blood glucose
values during the entire TH period and during each TH phase (induction, from the TH
initiation to the achievement of the target temperature; maintenance, 24 hours from
the end of induction; and rewarming, from the end of the maintenance to the achievement
of 36.5°C). The primary and secondary outcomes were mortality and neurological outcome
at 30 days. Multivariate regression analyses were performed with variables with a
significance level <0.1 on univariate analyses.
Results
The hypoglycemia rate increased significantly during the rewarming phase compared
with the maintenance phase (P = .003). The MAGC during the TH maintenance phase was an independent predictor of
mortality (OR = 1.056, 95% CI 1.008-1.107, P = .023) and unfavorable neurologic outcome (OR = 1.202, 95% CI 1.043-1.384, P = .038), while the MAGC during the rewarming phase and the entire TH period were
not.
Conclusion
The increased MAGC during the TH maintenance phase was associated with mortality and
unfavorable neurologic outcome. However, this study cannot prove a causal association
due to the retrospective design. In addition, we showed that the hypoglycemia rate
increased significantly during the rewarming phase.
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Article Info
Publication History
Published online: February 04, 2013
Accepted:
November 13,
2012
Received in revised form:
November 8,
2012
Received:
September 13,
2012
Footnotes
☆Funding Sources/Disclosures: The authors have no relevant financial information or potential conflicts of interest to disclose.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
