Blood glucose upon return of spontaneous circulation and neurological outcomes following out-of-hospital cardiac arrest

Abstract

Background

To elucidate the association between blood glucose levels at the return of spontaneous circulation (ROSC) and neurological outcomes following out-of-hospital cardiac arrest (OHCA), a post hoc analysis was conducted using data from a prospective observational study involving 41 hospitals in Tokyo and its suburbs from 2019 to 2021. Adults with nontraumatic OHCA who achieved ROSC were included.

Methods

A total of 1533 patients were analyzed. A spline curve for estimating neurological outcomes (Cerebral Performance Category score ≤2 at 30 days) by blood glucose level at ROSC was generated. Patients were classified into low, moderate, and high blood glucose groups, defined as <100, 100–300, and ≥300 mg/dL, respectively. Neurological outcomes were compared using generalized estimating equations adjusted for patient and institutional characteristics.

Results

Favorable neurologic outcomes were fewer in the low and high blood glucose groups than in the moderate group (8/132 [6.1 %] and 62/485 [12.8 %] vs. 181/807 [22.4 %]). The adjusted model revealed that low and high glucose levels at ROSC were associated with fewer favorable outcomes (odds ratios, 0.43 [0.18–0.96] and 0.59 [0.42–0.84]). High blood glucose levels showed unfavorable effects in subgroups with cardiogenic or noncardiogenic etiology, age <65 years, and low-flow time ≤30 min, whereas low blood glucose levels showed unfavorable effects only in cardiogenic cases.

Conclusions

Blood glucose levels <100 and ≥300 mg/dL were associated with unfavorable neurological outcomes, with a nonlinear inverted U-shaped relationship.