D-32 | Impact of Impaired Glucose Homeostasis in Non-Diabetic Patients with Cardiogenic Shock

Impaired glucose homeostasis leads to increased risk of fatal and non-fatal complications in patients with cardiovascular disease and diabetics mellitus. The impact of stress hyperglycemia on outcomes in patients with cardiogenic shock is not well studied in non diabetic patients. We conducted this analysis of the National Inpatient Sample (NIS) to evaluate the risk of hyperglycemia in cardiogenic shock in non diabetics patients with stress-induced hyperglycemia. We conducted a retrospective cohort study utilizing the NIS database from 2016-2020. We identified patients admitted to the CCU with cardiogenic shock and stratified them based on diagnosis of stress hyperglycemia and divided the group based on a diagnosis of pre-existing diabetes using the ICD-10 codes. We compared baseline characteristics using t-test and chi-square for continuous and categorical variables respectively. Multivariate regression analysis was used to adjust for potential confounders. Among 352,914 hospitalizations with cardiogenic shock, 102,929 had secondary diagnosis of stress hyperglycemia. Those with a pre-existing diagnosis of diabetes mellitus were excluded from the study. After adjusting for demographics, comorbidities, and hospital characteristics those with stress hyperglycemia had increased mortality (aOR: 7.25, p < 0.001, CI : 3.59 - 14.66) and length of stay additional days (p= 0.019, CI: 5.047 - 6.06). In terms of complications, patients with stress hyperglycemia had higher risk of acute myocardial infarction (aOR 2.51, p= 0.023, CI: 1.12 - 5.61), acute kidney injury (aOR 2.23, p = 0.003, CI: 1.186 - 4.18), pericardial effusions (aOR 1.94, p<0.001, CI: 1.48 - 3.745), acute respiratory failure and mechanical ventilation (aOR 3.24, p<0.001, CI: 5.91 - 7.16), and ischemic stroke (aOR 1.58, p <0.001, CI: 2.43 - 5.76). Stress hypoglycemia in non- diabetic patients admitted with cardiogenic shock was associated with increased mortality and other outcomes including acute myocardial infarction, pericardial effusions, respiratory failure and mechanical ventilation, ischemic stroke, and acute kidney injury.