title: Effect of diabetes and pre-hospital blood glucose level on survival and recovery after out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  Diabetes mellitus and blood glucose level (BGL) are emerging as important prognosticators of outcome in critically ill patients. We evaluated the effect of diabetes and pre-hospital BGL on survival to hospital discharge and on 12-month functional recovery after out-of-hospital cardiac arrest (OHCA).
  
  
  METHODS
  We performed a retrospective analysis of data from a statewide cardiac arrest registry in Victoria, Australia. We included 11 873 adult patients who had had an OHCA of presumed cardiac aetiology between 1 January 2007 and 30 June 2015. Of these, 2438 (20.5%) had documented diabetes.
  
  
  METHODS
  Survival to hospital discharge and 12-month functional recovery, measured using the Extended Glasgow Outcome Scale.
  
  
  RESULTS
  Crude survival to hospital discharge differed among patients with and without diabetes (6.8% v 13.4%; P < 0.001). Diabetes significantly reduced the odds of survival to hospital discharge for patients presenting with a shockable rhythm (adjusted odds ratio [OR], 0.57; 95% CI, 0.38-0.86; P = 0.007) and reduced the odds of good 12-month functional recovery for patients discharged alive (OR, 0.57; 95% CI, 0.35-0.95; P = 0.03). In contrast, a mild-to-moderate elevation of pre-hospital BGL (8.0- 15.9 mmol/L) was present in 695 of 1319 patients with available data (52.7%) and was associated with improved survival and functional recovery outcomes, which were independent of diabetes status.
  
  
  CONCLUSIONS
  Diabetes affects at least one in five patients who have had an OHCA and is associated with poorer survival and 12-month functional recovery after OHCA. In comparison, an elevated pre-hospital BGL is common in the peri-arrest period and may be associated with improved outcomes.
authors.affiliation: Department of Research and Evaluation, Ambulance Victoria, Melbourne, VIC, Australia. ziad.nehme@ambulance.vic.gov.au.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Nehme
authors.affiliation: Department of Research and Evaluation, Ambulance Victoria, Melbourne, VIC, Australia.
authors.forename: Resmi
authors.initials: R
authors.lastname: Nair
authors.affiliation: Department of Research and Evaluation, Ambulance Victoria, Melbourne, VIC, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Andrew
authors.affiliation: Department of Research and Evaluation, Ambulance Victoria, Melbourne, VIC, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bernard
authors.affiliation: Department of Research and Evaluation, Ambulance Victoria, Melbourne, VIC, Australia.
authors.forename: Marijana
authors.initials: M
authors.lastname: Lijovic
authors.affiliation: Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC, Australia.
authors.forename: Melanie
authors.initials: M
authors.lastname: Villani
authors.affiliation: Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC, Australia.
authors.forename: Sophia
authors.initials: S
authors.lastname: Zoungas
authors.affiliation: Department of Research and Evaluation, Ambulance Victoria, Melbourne, VIC, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D016887:Cardiopulmonary Resuscitation; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000097:blood / Q000401:mortality*; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood / Q000401:mortality* / Q000628:therapy; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D020127:Recovery of Function; D012189:Retrospective Studies; D016019:Survival Analysis; D014739:Victoria / Q000453:epidemiology
chemical_list: D001786:Blood Glucose