South Korea Cardiogenic Shock Study

A recent study in The American Journal of Cardiology showed that plasma glucose obtained at admission in cardiogenic shock is associated with in-hospital mortality in patients without diabetes mellitus (DM).

In patients with cardiogenic shock, the presence of hyperglycemia has been shown to affect the clinical outcome, but the extent of hyperglycemia and its association with prognosis has not been addressed fully in a large population. To address this topic, Seong Huan Choi, Division of Cardiology, Department of Medicine, South Korea, and colleagues enrolled a total of 1,177 consecutive patients with cardiogenic shock from January 2014 to December 2018 at 12 hospitals in South Korea.

Patients were categorized into 4 groups based on their initial plasma glucose level in patients with diabetes mellitus (DM) (n = 752) and patients without DM (n=425):

• Group 1 (≤8 mmol/L or 144 mg/100 ml)
• Group 2 (8 to 12 mmol/L or 144 to 216 mg/100 ml)
• Group 3 (12 to 16 mmol/L or 216 to 288 mg/100 ml)
• Group 4 (≥16 mmol/L or 288 mg/100 ml)

In-hospital mortality was the primary outcome. The findings of the study were as follows:

• The groups with higher admission plasma glucose were associated with lower systolic blood pressure and higher lactic acid levels in patients with and without DM.
• In-hospital mortality increased in groups with higher admission plasma glucose level in patients without DM:
  • Group 1: 24.2%
  • Group 2: 28.6%
  • Group 3: 38.1%
  • Group 4: 49.0%
• In patients with DM, mortality and admission plasma glucose level showed no significant association:
  • Group 1: 45%
  • Group 2: 35.4%
  • Group 3: 33.3%
  • Group 4: 43.1%
• Even after multivariate analysis, high plasma glucose was an independent predictor of in-hospital mortality in patients without DM.

To conclude, "in patients with cardiogenic shock, plasma glucose obtained at admission was associated with in-hospital mortality in patients without DM."

Reference

Choi SH, Yoon GS, Lee MJ, Park SD, Ko YG, Ahn CM, Yu CW, Chun WJ, Jang WJ, Kim HJ, Kim BS, Bae JW, Lee SY, Kwon SU, Kim JS, Lee WS, Jeong JO, Lim SH, Cho S, Yang JH, Gwon HC. Prognostic Impact of Plasma Glucose on Patients With Cardiogenic Shock With or Without Diabetes Mellitus from the SMART RESCUE Trial. Am J Cardiol. 2022 May 9:S0002-9149(22)00415-5. doi: 10.1016/j.amjcard.2022.04.008. Epub ahead of print. PMID: 35550823.