院外心脏骤停后自发循环恢复后的血糖和神经系统预后

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus Pub Date : 2025-09-05 DOI:10.1016/j.resplu.2025.101088

Ryo Yamamoto , Kazuki Matsumura , Daiki Kaito , Tomoyoshi Tamura , Koichiro Homma , Masaru Suzuki , Tomohisa Nomura , Nobuya Kitamura , Takashi Tagami , Hideo Yasunaga , Shotaro Aso , Junichi Sasaki , SOS-KANTO 2017 Study Group

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引用次数: 0

摘要

为了阐明院外心脏骤停（OHCA）后自发循环恢复（ROSC）时血糖水平与神经系统预后之间的关系，研究人员利用2019年至2021年东京及其郊区41家医院的前瞻性观察性研究数据进行了事后分析。获得ROSC的非创伤性OHCA成人纳入研究对象。方法对1533例患者的临床资料进行分析。通过ROSC时的血糖水平，生成一条样条曲线来估计神经预后（30天时脑功能分类评分≤2）。将患者分为低血糖组、中度血糖组和高血糖组，分别定义为100mg /dL、100 - 300 mg/dL和≥300mg /dL。神经学结果的比较采用根据患者和机构特征调整的广义估计方程。结果低血糖组和高血糖组的神经系统预后较中度血糖组少（8/132[6.1%]和62/485[12.8%]对181/807[22.4%]）。调整后的模型显示，ROSC低血糖和高血糖水平与较少的有利结果相关（优势比分别为0.43[0.18-0.96]和0.59[0.42-0.84]）。高血糖对心源性或非心源性病因、年龄及65岁、低流时间≤30 min的亚组均有不利影响，而低血糖仅对心源性病例有不利影响。结论100和≥300 mg/dL的血糖水平与神经系统预后不良相关，呈非线性倒u型关系。

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

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.