Prognostic value of baseline glucose levels for mortality in patients with cardiogenic shock: a systematic review and meta-analysis

Abstract

Background: Baseline glucose levels have been implicated in the prognosis of critically ill patients. However, the prognostic value of glucose in patients with cardiogenic shock (CS) has not been systematically evaluated. The current study aimed to provide evidence that baseline glucose levels can predict mortality in patients with CS.

Methods: PubMed, Scopus, Embase and Web of Science were searched from inception to July 31, 2024 for studies assessing mortality after CS based on different baseline glucose levels. Hyperglycemia was defined as a glucose level > 7.8-8 mmol/l. Data were synthesized using "Review Manager" (RevMan; version 5.3; The Cochrane Collaboration).

Results: A total of nine studies were included. Meta-analysis showed that patients with CS who had baseline glucose levels > 7.8-8 mmol/l had a significantly greater risk of early mortality as compared to those with glucose levels < 7.8-8 mmol/l [risk ratio (RR), 1.48; 95% confidence interval (CI), 1.24-1.77; I-squared (I²) = 65%]. Similarly, patients with CS who had baseline glucose levels > 10-11 mmol/l (RR, 1.98; 95% CI, 1.35-2.90; I² = 82%) and 11.5-12mmol/l (RR, 1.43; 95% CI, 1.19-1.72; I² = 74%) had significantly greater risk of early mortality as compared to those with lower levels. Severe hyperglycemia (> 16 mmol/l) was also associated with an increased risk of mortality compared with normoglycemia (RR, 1.84; 95% CI, 1.36-2.48; I² = 78%).

Conclusion: In the present meta-analysis, the elevated risk of mortality was persistent with different glucose cut-offs, suggesting that glucose levels at admission can be useful for risk assessment in patients with CS. Further studies considering diabetes status and other important confounding factors are needed to obtain more evidence.

Keywords: Cardiogenic shock; Diabetes; Glucose; Hyperglycemia; Mortality.

Fig. 1

Search results presented as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart

Fig. 2

Meta-analysis comparing early mortality rates of cardiogenic shock between hyperglycemia (> 7.8-8 mmol/l) and normoglycemia groups. CI, confidence interval

Fig. 3

Funnel plot of the primary meta-analysis. SE, standard error; RR, relative risk

Fig. 4

Meta-analysis comparing early mortality rates of cardiogenic shock based on cut-off glucose levels of 10–11 and 11.5–12 mmol/l. CI, confidence interval

Fig. 5

Meta-analysis comparing early mortality rates of cardiogenic shock with glucose levels > 10–11 and > 11.5–12 mmol/l vs. <8 mmol/l. CI, confidence interval

Fig. 6

Meta-analysis comparing early mortality rates of cardiogenic shock with glucose levels > 16 mmol/l vs. <8mmol/l. CI, confidence interval