Association between Blood Glucose and cardiac Rhythms during pre-hospital care of Trauma Patients – a retrospective Analysis

Kreutziger, Janett; Schmid, Stefan; Umlauf, Nikolaus; Ulmer, Hanno; Nijsten, Maarten W. N.; Werner, D.; Schlechtriemen, T.; Lederer, Wolfgang

doi:10.1186/s13049-018-0516-z

Cited by 10 publications

(9 citation statements)

References 58 publications

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“…In contrast, the threshold of 250 mg/dL (13.88 mmol/L) is one of the diagnostic criteria for diabetic ketoacidosis, a life-threatening complication of hyperglycemia [ 18 ]. However, prior studies on the effects of hypoglycemia on cardiac arrests used a wide range of cut-off values ranging from 100–150 mg/dL [ 6 , 9 , 14 , 19 ]. According to the American Diabetes Association (ADA) and American Association of Clinical Endocrinologists (AACE) task force on inpatient glycemic control [ 20 ], a glucose level between 140 and 180 mg/dL has been recommended for the ICU patients [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, the benefit of intra-arrest BG normalization during CPR is not well-documented. As a result, this study aims to investigate a relationship between BG level and resuscitation outcomes, including the probability of ROSC, survival to hospital admission, survival to hospital discharge, and favorable neurological outcome at hospital discharge [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Association between Intra-Arrest Blood Glucose Level and Outcomes of Resuscitation at the Emergency Department: A Retrospective Study

Wongtanasarasin

Ungrungseesopon

Phinyo

2022

JCM

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Since current cardiac arrest guidelines do not address the benefit of blood glucose measurement, the ideal ranges and target of blood glucose (BG) levels during cardiac arrest to achieve a better result are warranted. We intended to investigate the associations between intra-arrest BG levels and outcomes of cardiac arrest resuscitation at the emergency department (ED). We conducted a retrospective observational study at a single university hospital. Cardiac arrest patients at the ED between 2017 and 2020 were included. Multivariable logistic regression analysis was performed to examine the associations between intra-arrest BG levels and clinical outcomes. We categorized intra-arrest BG into five groups: <70 mg/dL, 70–99 mg/dL, 100–180 mg/dL, 181–250 mg/dL, and >250 mg/dL. Eight hundred and nineteen patients experienced ED cardiac arrest during the study period. Of all, 385 intra-arrest BG measurements were included in the data analysis. The mean age was 60.4 years. The mean intra-arrest BG level was 171.1 mg/dL, with 64 (16.6%) patients who had intra-arrest BG level below 70 mg/dL and 73 (19.0%) patients who had intra-arrest BG level more than 250 mg/dL. Markedly low (<70 mg/dL) and low (70–99 mg/dL) intra-arrest BG levels were significantly associated with a lower chance of return of spontaneous circulation (ROSC, OR 0.36, 95% CI 0.14–0.99, p = 0.05 and OR 0.33, 95% CI 0.12–0.93, p = 0.04, respectively). For patients who experienced cardiac arrest at the ED, an intra-arrest BG level of less than 100 was inversely correlated with sustained ROSC. Although we could not draw a causal relationship between variables concerning this study design, normalizing intra-arrest BG was shown to result in good clinical outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between Intra-Arrest Blood Glucose Level and Outcomes of Resuscitation at the Emergency Department: A Retrospective Study

Wongtanasarasin

Ungrungseesopon

Phinyo

2022

JCM

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“…Over the last two decades, a vast number of publications have demonstrated the fundamental role of stress hyperglycemia in critical injury [1][2][3][4] and diverse critical conditions [21][22][23][24]. Up to date, there has been no consistency in de ning blood glucose levels, wherefore this trial resigns from specifying any threshold values for stress hyperglycemia.…”

Section: Discussionmentioning

confidence: 99%

“…Stress hyperglycemia is common in trauma patients and critical illness upon hospital admission and is often associated with worse outcome [1][2][3][4]. Hemorrhage aggravates this stress hyperglycemia signi cantly [5,6].…”

Section: Introductionmentioning

confidence: 99%

Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma (AAST V) – A Register Analysis

Kreutziger

Fodor

Morell-Hofert

et al. 2021

Preprint

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Background: Stress hyperglycemia is common in trauma patients. Increasing injury severity and hemorrhage is known to trigger hepatic gluconeogenesis and glycogenolysis and also peripheral and hepatic insulin resistance. Consequently, we expect glucose levels to rise with injury severity in liver, kidney and spleen injuries. In contrast, we hypothesized that in the most severe form of blunt liver injury, stress hyperglycemia may be absent despite critical injury and hemorrhage.Methods: All patients with documented liver, kidney or spleen injuries, treated at a single, university hospital in Austria between 2000 and 2020 were charted in a register. Besides demographic, laboratory, radiological, surgical and other data were analyzed.Results: A total of 772 patients were included. In liver (n=456), spleen (n=375) and kidney (n=152) trauma, an increasing injury severity past moderate to severe (AAST III-IV) was associated with a concomitant rise in blood glucose levels independent of the affected organ. While this stress induced hyperglycemia was even more pronounced in the most severe forms (AAST V) of spleen (median 10.7 mmol/L, p<0.0001) and kidney injuries (median 10.6 mmol/L, p=0.004), it was absent in AAST V liver injuries, where median blood glucose level even fell (5.6 mmol/L, p<0.0001). Conclusions: Absence of stress hyperglycemia is a sign of most severe liver injury (AAST V) and should prompt fundamental diagnostic and therapeutic procedures. Blood glucose should be considered as an additional diagnostic criterion in liver injury.

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“…Stress hyperglycemia is common in trauma patients, and critical illness on hospital admission and is often associated with poor outcome [1][2][3][4][5][6][7]. This stress hyperglycemia is caused by neuroendocrine, inflammatory and metabolic responses to trauma-associated stressors.…”

Section: Introductionmentioning

confidence: 99%

Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma

et al. 2021

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Background: Stress hyperglycemia is common in trauma patients. Increasing injury severity and hemorrhage trigger hepatic gluconeogenesis, glycogenolysis, peripheral and hepatic insulin resistance. Consequently, we expect glucose levels to rise with injury severity in liver, kidney and spleen injuries. In contrast, we hypothesized that in the most severe form of blunt liver injury, stress hyperglycemia may be absent despite critical injury and hemorrhage. Methods: All patients with documented liver, kidney or spleen injuries, treated at a university hospital between 2000 and 2020 were charted. Demographic, laboratory, radiological, surgical and other data were analyzed. Results: A total of 772 patients were included. In liver (n = 456), spleen (n = 375) and kidney (n = 152) trauma, an increase in injury severity past moderate to severe (according to the American Association for the Surgery of Trauma, AAST III-IV) was associated with a concomitant rise in blood glucose levels independent of the affected organ. While stress-induced hyperglycemia was even more pronounced in the most severe forms (AAST V) of spleen (median 10.7 mmol/L, p < 0.0001) and kidney injuries (median 10.6 mmol/L, p = 0.004), it was absent in AAST V liver injuries, where median blood glucose level even fell (5.6 mmol/L, p < 0.0001). Conclusions: Absence of stress hyperglycemia on hospital admission could be a sign of most severe liver injury (AAST V). Blood glucose should be considered an additional diagnostic criterion for grading liver injury.

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Association between Blood Glucose and cardiac Rhythms during pre-hospital care of Trauma Patients – a retrospective Analysis

Cited by 10 publications

References 58 publications

Association between Intra-Arrest Blood Glucose Level and Outcomes of Resuscitation at the Emergency Department: A Retrospective Study

Association between Intra-Arrest Blood Glucose Level and Outcomes of Resuscitation at the Emergency Department: A Retrospective Study

Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma (AAST V) – A Register Analysis

Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma

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