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Proportion of time spent in blood glucose range 70 to 140?mg/dL is associated with increased survival in patients admitted to ICU after cardiac arrest: A multicenter observational study.

ABSTRACT: The benefit of any specific target range of blood glucose (BG) for post-cardiac arrest (PCA) care remains unknown.We conducted a multicenter retrospective study of prospectively collected data of all cardiac arrest patients admitted to the ICUs between 2014 and 2015. The main exposure was BG metrics during the first 24?hours, including time-weighted mean (TWM) BG, mean BG, admission BG and proportion of time spent in 4 BG ranges (<=?70?mg/dL, 70-140?mg/dL, 140-180?mg/dL and > 180?mg/dL). The primary outcome was hospital mortality. Multivariable logistic regression, Cox proportion hazard models and generalized estimating equation (GEE) models were built to evaluate the association between the different kinds of BG and hospital mortality.2,028 PCA patients from 144 ICUs were included. 14,118 BG measurements during the first 24?hours were extracted. According to TWM-BG, 9 (0%) were classified into the <=?70?mg/dL range, 693 (34%) into the 70 to 140?mg/dL range, 603 (30%) into the 140 to 180?mg/dL range, and 723 (36%) into the >?180?mg/dL range. Compared with BG 70 to 140?mg/dL range, BG 140 to 180?mg/dL range and >?180?mg/dL range were associated with higher hospital mortality probability. Proportion of time spent in the 70 to 140?mg/dL range was associated with good outcome (odds ratio 0.984, CI [0.970, 0.998], P =?.022, for per 5% increase in time), and >?180?mg/dL range with poor outcome (odds ratio 1.019, CI [1.009, 1.028], P< .001, for per 5% increase in time). Results of the 3 kinds of statistical models were consistent.The proportion of time spent in BG range 70 to 140?mg/dL is strongly associated with increased hospital survival in PCA patients. Hyperglycemia (> 180?mg/dL) is common in PCA patients and is associated with increased hospital mortality.

SUBMITTER: Zhou D

PROVIDER: S-EPMC7437796 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Proportion of time spent in blood glucose range 70 to 140 mg/dL is associated with increased survival in patients admitted to ICU after cardiac arrest: A multicenter observational study.

Zhou Dawei D Li Zhimin Z Shi Guangzhi G Zhou Jianxin J

Medicine 20200801 33

The benefit of any specific target range of blood glucose (BG) for post-cardiac arrest (PCA) care remains unknown.We conducted a multicenter retrospective study of prospectively collected data of all cardiac arrest patients admitted to the ICUs between 2014 and 2015. The main exposure was BG metrics during the first 24 hours, including time-weighted mean (TWM) BG, mean BG, admission BG and proportion of time spent in 4 BG ranges (<= 70 mg/dL, 70-140 mg/dL, 140-180 mg/dL and > 180 mg/dL). The pri ...[more]

PMID: 32872055

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Project description:BackgroundThe risk of stroke in individuals with very low low-density lipoprotein cholesterol (LDL-C) concentrations remains high. We sought to prioritize predictive risk factors for stroke in Chinese participants with LDL-C concentrations < 70 mg/dL using a survival conditional inference tree, a machine learning method.MethodsThe training dataset included 9327 individuals with LDL-C concentrations < 70 mg/dL who were free of cardiovascular diseases and did not use lipid-modifying drugs from the Kailuan I study (N = 101,510). We examined the validity of this algorithm in a second Chinese cohort of 1753 participants with LDL-C concentrations < 70 mg/dL from the Kailuan II study (N = 35,856).ResultsDuring a mean 8.5-9.0-year follow-up period, we identified 388 ischemic stroke cases and 145 hemorrhagic stroke cases in the training dataset and 20 ischemic stroke cases and 8 hemorrhagic stroke cases in the validation dataset. Of 15 examined predictors, poorly controlled blood pressure and very low LDL-C concentrations (≤ 40 mg/dL) were the top hierarchical predictors of both ischemic stroke risk and hemorrhagic stroke risk. The groups, characterized by the presence of 2-3 of aforementioned risk factors, were associated with a higher risk of ischemic stroke (hazard ratio (HR) 7.03; 95% confidence interval (CI) 5.01-9.85 in the training dataset; HR 4.68, 95%CI 1.58-13.9 in the validation dataset) and hemorrhagic stroke (HR 3.94, 95%CI 2.54-6.11 in the training dataset; HR 4.73, 95%CI 0.81-27.6 in the validation dataset), relative to the lowest risk groups (presence of 0-1 of these factors). There was a linear association between cumulative average LDL-C concentrations and stroke risk. LDL-C concentrations ≤ 40 mg/dL was significantly associated with increased risk of ischemic stroke (HR 2.07, 95%CI 1.53, 2.80) and hemorrhagic stroke (HR 2.70, 95%CI 1.70, 4.30) compared to LDL-C concentrations of 55-70 mg/dL, after adjustment for age, hypertension status, and other covariates.ConclusionIndividuals with extremely low LDL-C concentrations without previous lipid-modifying treatment could still be at high stroke risk.Trial registrationChinese Clinical Trial Register, ChiCTR-TNRC-11001489 . Registered on 24-08-2011.

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Dataset Information

Proportion of time spent in blood glucose range 70 to 140?mg/dL is associated with increased survival in patients admitted to ICU after cardiac arrest: A multicenter observational study.

Publications

Proportion of time spent in blood glucose range 70 to 140 mg/dL is associated with increased survival in patients admitted to ICU after cardiac arrest: A multicenter observational study.

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