title: The Relationship Between the Decreased Rate of Initial Blood Glucose and Neurologic Outcomes in Survivors of Out-of-Hospital Cardiac Arrest Receiving Therapeutic Hypothermia.
abstract: BACKGROUND
  Hyperglycemia in out-of-hospital cardiac arrest (OHCA) survivors is associated with poor outcomes. However, in the control of initial hyperglycemia, an adequate strategy to improve patients' neurologic outcomes remains undetermined. Prior to the establishment of such strategy, we need to determine whether a decreased rate of initial blood glucose (BG) affects patient outcomes.
  
  
  METHODS
  One hundred and forty-five adult non-traumatic OHCA survivors treated with therapeutic hypothermia between April 2007 and December 2011 were enrolled in this single-center retrospective cohort study. Based on the cerebral performance category (CPC) at 6 months after OHCA, study populations were categorized as "Good CPC group" (favorable outcome, CPC1 and CPC2) and "Poor CPC group" (unfavorable outcome, CPC3-CPC5). Variables related to BG were obtained, and the rate of BG change was calculated.
  
  
  RESULTS
  In the Good CPC group, the time required to attain target BG levels was shorter [7.4 (2.97-18.13) vs. 13.17 (7.55-27.0) h, p < 0.001], and the average rate of glucose decrease until the attainment of target BG levels was faster [17.06 (6.67-34.49) vs. 8.33 (4.26-18.55) mg/dl/h, p = 0.005] than in the Poor CPC group. Using multivariate analysis, the faster rate (odds ratio 1.074; 95% confidence interval 1.029-1.12; p = 0.001) and the shorter time (odds ratio 13.888; 95% confidence interval 2.271-84.906; p = 0.004) required to attain target BG levels were independently related to favorable neurologic outcomes.
  
  
  CONCLUSIONS
  Faster rates of initial BG decrease and the shorter time required to attain target BG levels were associated with favorable neurologic outcome in survivors of OHCA receiving therapeutic hypothermia.
authors.affiliation: Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, 1198, Guwol-dong, Namdong-gu, Incheon, 405-760, South Korea.
authors.forename: Jae-Hyug
authors.initials: JH
authors.lastname: Woo
authors.affiliation: Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, 1198, Guwol-dong, Namdong-gu, Incheon, 405-760, South Korea. yongem@gmail.com.
authors.forename: Yong Su
authors.initials: YS
authors.lastname: Lim
authors.affiliation: Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, 1198, Guwol-dong, Namdong-gu, Incheon, 405-760, South Korea.
authors.forename: Hyuk Jun
authors.initials: HJ
authors.lastname: Yang
authors.affiliation: Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, 1198, Guwol-dong, Namdong-gu, Incheon, 405-760, South Korea.
authors.forename: Sung Youl
authors.initials: SY
authors.lastname: Hyun
authors.affiliation: Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, 1198, Guwol-dong, Namdong-gu, Incheon, 405-760, South Korea.
authors.forename: Jin Seong
authors.initials: JS
authors.lastname: Cho
authors.affiliation: Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, 1198, Guwol-dong, Namdong-gu, Incheon, 405-760, South Korea.
authors.forename: Jin Joo
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, 1198, Guwol-dong, Namdong-gu, Incheon, 405-760, South Korea.
authors.forename: Gun
authors.initials: G
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood* / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017741:Survivors
chemical_list: D001786:Blood Glucose
keywords: Blood glucose; Heart arrest; Hyperglycemia; Hypothermia; Induced; Insulin; Out-of-hospital cardiac arrest