Abstract Background Stress hyperglycaemia (SH) is common in critically ill patients and is associated with an adverse outcome in acute myocardial infarction (AMI) and acute heart failure. However, there are limited data on SH in patients with cardiogenic shock (CS). Objectives To evaluate the association between fasting hyperglycaemia and mortality in patients with CS. Methods Shock-CAT study was a multicentre, prospective, observational study conducted from December 2018 to November 2019 in eight University hospitals in Catalonia, including non-selected consecutive CS patients. Patients are classified into two groups according to the presence of SH, which is defined as fasting blood glucose (FBG) 140mg/dL in the first 24h of admission. The presence of diabetes was defined as a previous diagnosis of diabetes and/or an HbA1c ≥6.5% on admission. Data on clinical presentation, management, including mechanical circulatory support (MCS), clinical outcomes, in-hospital mortality and mid-term mortality were analysed. Results 365 patients with cardiogenic shock are included. The prevalence of SH is 72.9%. Mean age 65.4 years. 24.6% were women. The SH group is older (age 66.6 years vs 62.2 years, P = 0.014) and more prevalence of women (21.8% vs 32.3%, P = 0.038) and diabetes (45.9% vs 27.3%, P = 0.001). AMI was the main cause of CS (61.1%) with higher prevalence in SH patients (64.7% vs 51.5%, P = 0.022). Haemodynamic parameters and mean left ventricle ejection fraction were similar between groups. SH patients have higher FBG (237.1mg/dL vs 114mg/dL, P 0.001), lactate peak (5.4mmol/L vs 4mmol/L, P = 0.028), CardShock risk score (4.6 vs 3.7, P 0.001), prevalence of INTERMACS 1-2 (50.8% vs 35.4%, P = 0.009) and SCAI D/E (39.1% vs 25.3%, P = 0.014), and lower pH at admission (7.25 vs 7.33, P 0.001). Overall, 35.3% of patients received MCS, without significant difference between the groups. In-hospital mortality was higher in the SH group (38.2% vs 17.2%, P 0.001), with three-fold increased risk after multivariate adjustment (OR 3.33, P = 0.007). Conclusions In our cohort, more than 70% had stress hyperglycemia, and approximately one-third experienced in-hospital mortality. Fasting blood glucose levels exceeding 140 mg/dL are independently associated with mortality in cardiogenic shock of any etiology, leading to a threefold increase in in-hospital mortality regardless of diabetic status.
Rovira et al. (Sat,) studied this question.