title: Association of blood glucose variability with outcomes in comatose cardiac arrest survivors treated with therapeutic hypothermia.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors: Byung Kook
authors: BK
authors: Lee
authors: Hyoung Youn
authors: HY
authors: Lee
authors: Kyung Woon
authors: KW
authors: Jeung
authors: Yong Hun
authors: YH
authors: Jung
authors: Geo Sung
authors: GS
authors: Lee
authors: Yeonho
authors: Y
authors: You
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D003128:Coma / Q000097:blood / Q000209:etiology*; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007036:Hypothermia, Induced; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D017741:Survivors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose