In patients without diabetes mellitus (DM) who are in cardiogenic shock, admission plasma glucose level proportionately increased the rate of in-hospital mortality. These findings were published in The American Journal of Cardiology.
The investigator-initiated, prospective, retrospective, multicenter RESCUE-SMART trial (ClinicalTrials.gov identifier: NCT02985008) was conducted at 12 hospitals in South Korea. The investigators sought to evaluate the extent of hyperglycemia and its association with prognosis in a large population of patients hospitalized with cardiogenic shock. The primary study outcome was in-hospital mortality during the follow-up period. The researchers also analyzed the use of such cardiac support devices as extracorporeal membrane oxygenation along with a mechanical ventilator, an intra-aortic balloon pump, and continuous renal replacement therapy.
Study inclusion criteria were systolic blood pressure (SBP) of less than 90 mm Hg for over 30 minutes or catecholamine or vasopressor required to maintain pressure of more than 90 mm Hg during systole and clinical signs of pulmonary congestion and signs of impaired organ perfusion with 1 or more of these criteria: altered mental status; cold, clammy skin and extremities; oliguria with urine output of less than 0.5 mL/kg/h for the first 6 hours of admission; and serum lactate of greater than 2.0 mmol/L.
A total of 1177 consecutive patients with cardiogenic shock were enrolled between January 2014 and December 2018. Of the 1177 participants, 425 had DM and 752 did not have DM. The median hospitalization time was 10 days (range, 4-21 days).
Patients were divided into 4 groups based on their glucose level at hospital admission which included group 1 (≤8 mmol/L [144 mg/100 mL]), group 2 (8 to12 mmol/L [144 to 216 mg/100 mL]), group 3 (12 to 16 mmol/L [216 to 288 mg/100 mL]), and group 4 (≥16 mmol/L [288 mg/100 mL]). In all 4 groups of patients, both with and without DM, the most common cause of cardiogenic shock was ischemic cardiomyopathy.
Those groups of participants, both with and without DM, who had higher serum glucose levels at hospitalization had lower SBP and higher lactic levels. In-hospital mortality increased significantly in groups with higher plasma glucose concentrations at admission among those without DM (group 1: 24.2%; group 2: 28.6%; group 3: 38.1%; group 4: 49.0%; P <.01). In contrast, in those participants with DM, no significant association was observed between mortality and plasma glucose level at admission (group 1: 45.0%; group 2: 35.4%; group 3: 33.3%; group 4: 43.1%; P <.26).
Following multivariate analysis, high plasma glucose concentration was an independent predictor of in-hospital mortality in participants without DM.
Limitations of the current study include the fact that patients with hypoglycemia were not excluded from the analysis and were considered as group 1. The inclusion of these individuals might have influenced the mortality rate among those in this group, both those with and those without DM.
“In conclusion, admission serum glucose level proportionately increased in-hospital mortality in patients without DM with cardiogenic shock,” the study authors wrote. “Multivariate cox regression analysis showed that severe hyperglycemia was a poor prognostic factor in patients without DM.”
Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.
Choi SH, Yoon G-S, Lee M-J, et al. Prognostic impact of plasma glucose on patients with cardiogenic shock with or without diabetes mellitus from the SMART RESCUE trial. Am J Cardiol. Published online May 9, 2022. doi:10.1016/j.amjcard.2022.04.008