Effect of diabetes and pre-hospital blood glucose level on survival and recovery after out-of-hospital cardiac arrest

Ziad Nehme, Resmi Nair, Emily Andrew, Stephen Bernard, Marijana Lijovic, Melanie Villani, Sophia Zoungas, Karen Smith

Research output: Contribution to journal › Article › Research

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). Design, setting and participants: 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. Main outcome measures: 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.

Original languageEnglish
Pages (from-to)69-77
Number of pages9
JournalCritical Care and Resuscitation
Volume18
Issue number2
Publication statusPublished - 1 Jun 2016

Cite this

Nehme, Ziad ; Nair, Resmi ; Andrew, Emily ; Bernard, Stephen ; Lijovic, Marijana ; Villani, Melanie ; Zoungas, Sophia ; Smith, Karen. / Effect of diabetes and pre-hospital blood glucose level on survival and recovery after out-of-hospital cardiac arrest. In: Critical Care and Resuscitation. 2016 ; Vol. 18, No. 2. pp. 69-77.
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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). Design, setting and participants: 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. Main outcome measures: 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.",
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Nehme, Z, Nair, R, Andrew, E, Bernard, S, Lijovic, M, Villani, M, Zoungas, S & Smith, K 2016, 'Effect of diabetes and pre-hospital blood glucose level on survival and recovery after out-of-hospital cardiac arrest' Critical Care and Resuscitation, vol. 18, no. 2, pp. 69-77.

Effect of diabetes and pre-hospital blood glucose level on survival and recovery after out-of-hospital cardiac arrest. / Nehme, Ziad; Nair, Resmi; Andrew, Emily; Bernard, Stephen; Lijovic, Marijana; Villani, Melanie; Zoungas, Sophia; Smith, Karen.

In: Critical Care and Resuscitation, Vol. 18, No. 2, 01.06.2016, p. 69-77.

Research output: Contribution to journal › Article › Research

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AU - Andrew, Emily

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AU - Villani, Melanie

AU - Zoungas, Sophia

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N2 - 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). Design, setting and participants: 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. Main outcome measures: 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.

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Nehme Z, Nair R, Andrew E, Bernard S, Lijovic M, Villani M et al. Effect of diabetes and pre-hospital blood glucose level on survival and recovery after out-of-hospital cardiac arrest. Critical Care and Resuscitation. 2016 Jun 1;18(2):69-77.

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