title: The association of admission blood glucose level with the clinical picture and prognosis in cardiogenic shock - Results from the CardShock Study.
abstract: BACKGROUND
  Critically ill patients often present with hyperglycemia, regardless of previous history of diabetes mellitus (DM). Hyperglycemia has been associated with adverse outcome in acute myocardial infarction and acute heart failure. We investigated the association of admission blood glucose level with the clinical picture and short-term mortality in cardiogenic shock (CS).
  
  
  METHODS
  Consecutively enrolled CS patients were divided into five categories according to plasma glucose level at the time of enrolment: hypoglycemia (glucose <4.0mmol/L), normoglycemia (4.0-7.9mmol/L), mild (8.0-11.9mmol/L), moderate (12.0-15.9mmol/L), and severe (≥16.0mmol/L) hyperglycemia. Clinical presentation, biochemistry, and short-term mortality were compared between the groups.
  
  
  RESULTS
  Plasma glucose level of 211 CS patients was recorded. Glucose levels were distributed equally between normoglycemia (26% of patients), mild (27%), moderate (19%) and severe (25%) hyperglycemia, while hypoglycemia (2%) was rare. Severe hyperglycemia was associated with higher blood leukocyte count (17.3 (5.8) E9/L), higher lactate level (4.4 (3.3-8.4) mmol/L) and lower arterial pH (7.23 (0.14)) compared with normoglycemia or mild to moderate hyperglycemia (p<0.001 for all). In-hospital mortality was highest among hypoglycemic (60%) and severely hyperglycemic (56%) patients, compared with 22% in normoglycemic group (p<0.01). Severe hyperglycemia was an independent predictor of in-hospital mortality (OR 3.7, 95% CI 1.19-11.7, p=0.02), when adjusted for age, gender, LVEF, lactate, and DM.
  
  
  CONCLUSIONS
  Admission blood glucose level has prognostic significance in CS. Mortality is highest among patients with severe hyperglycemia or hypoglycemia. Severe hyperglycemia is independently associated with high in-hospital mortality in CS. It is also associated with biomarkers of systemic hypoperfusion and stress response.
authors: Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland. Electronic address: anu.kataja@helsinki.fi.
authors: Anu
authors: A
authors: Kataja
authors: Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
authors: Tuukka
authors: T
authors: Tarvasmäki
authors: Cardiology, University of Helsinki, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
authors: Johan
authors: J
authors: Lassus
authors: CINTESIS - Center for Health Technology and Services Research, Department of Cardiology, Faculty of Medicine, University of Porto, São João Medical Center, Porto, Portugal.
authors: Jose
authors: J
authors: Cardoso
authors: INSERM U942, Hopital Lariboisiere, APHP and University Paris Diderot, Paris, France.
authors: Alexandre
authors: A
authors: Mebazaa
authors: Rigshospitalet, Copenhagen University Hospital, Division of Heart Failure, Pulmonary Hypertension and Heart Transplantation, Copenhagen, Denmark.
authors: Lars
authors: L
authors: Køber
authors: Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat de Barcelona, Barcelona, Spain.
authors: Alessandro
authors: A
authors: Sionis
authors: Internal Cardiology Department, University Hospital Brno and Masaryk University, Brno, Czech republic.
authors: Jindrich
authors: J
authors: Spinar
authors: Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Brescia, Italy.
authors: Valentina
authors: V
authors: Carubelli
authors: Intensive Cardiac Therapy Clinic, Institute of Cardiology, Warsaw, Poland.
authors: Marek
authors: M
authors: Banaszewski
authors: Department of Medical Sciences and Translational Medicine, University of Rome Sapienza, Emergency Department, Sant''Andrea Hospital, Rome, Italy.
authors: Rossella
authors: R
authors: Marino
authors: Heart Failure Clinic, Attikon University Hospital, Athens, Greece.
authors: John
authors: J
authors: Parissis
authors: Cardiology, University of Helsinki, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
authors: Markku S
authors: MS
authors: Nieminen
authors: Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
authors: Veli-Pekka
authors: VP
authors: Harjola
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D010343:Patient Admission / Q000639:trends*; D011379:Prognosis; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality
chemical_list: D001786:Blood Glucose
keywords: Acute coronary syndrome; Blood glucose; Cardiogenic shock; Hyperglycemia; Hypoglycemia; Prognosis