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Introduction: Understanding the characteristics of survivor after return of spontaneous circulation (ROSC) in patients with cardiopulmonary arrest (CPA) may help us to select the optimal management. Hypothesis: We hypothesized that the prognosis and predictors of survivor after ROSC could be different between cardiac and non-cardiac CPA patients. Method: We retrospectively analyzed consecutive 85 patients with CPA and ROSC after cardiopulmonary resuscitation (CPR) in our hospital and divided them into cardiogenic (n=35) and non-cardiogenic (n=50) CPA. We analyzed age, gender, bystander CPR, duration of CPA, pupil diameter at admission, Glasgow coma scale, total protein (TP) level, creatinine level, pH of arterial blood and death in hospital. Result: The 17 patients died in cardiogenic CPA and 40 patients in non-cardiogenic CPA. The Kaplan-Meier curve demonstrated the better prognosis in cardiogenic CPA compared with non-cardiogenic CPA (Figure). In both CPA, duration of CPA was shorter and total TP level was higher in survival than those in dead group. In cardiogenic CPA, age was younger and creatinine level was lower in survival group compared with dead group (Table). In non-cardiogenic CPA, pupil diameter was smaller in survival group compared with dead group. Furthermore, in TP levels, the receiver operating characteristic (ROC) curve for survival after ROSC demonstrated that the area under curve (AUC) was 0.82 and provided an optimal cut-off value at 6.2 mg/dl of TP with 71% sensitivity and 83% specificity. In non-cardiogenic CPA, ROC curve demonstrated that AUC was 0.73 and 59% sensitivity, and 100% specificity at the optimal cut-off value of TP 6.0 mg/dl. Therefore, TP levels may be the better prognostic predictor in cardiogenic CPA compared with non-cardiogenic CPA. Conclusion: Although duration of CPA and TP levels were common predictor for survival after ROSC in CPA, there were different prognostic predictors in cardiogenic or non-cardiogenic CPA.

Background Sodium-glucose cotransporter 2 (SGLT2) inhibitors are reported to have BP-lowering effect in addition to blood glucose-lowering effect, however, its mechanism is still unknown. This study aimed to investigate the mechanism of blood pressure (BP) lowering effects of SGLT2 inhibitors using 24-h urinary collection in obese type 2 diabetes patients. Methods Twenty patients with type 2 diabetes (age 48.2 ± 10.7 years, BMI 33.0 ± 4.9 kg/m2) were enrolled. Urine volume, 24-h urinary glucose and sodium excretion, and BP at baseline and 2 weeks and 6 months after administration were measured. Body weight, glycosylated hemoglobin, and BP were evaluated before and 1, 3, and 6 months after SGLT2 inhibitor administration. We evaluated the changes in urine volume and urinary excretion of glucose and sodium as well as correlations among urine volume and urinary sodium glucose excretion at 2 weeks and 6 months after administration of the SGLT2 inhibitors. Furthermore, we investigated the correlations between changes in BP and urinary excretion of sodium and glucose at the same time. Results Two weeks after administration, systolic BP (SBP) significantly decreased (128.5 ± 11.0 to 123.2 ± 9.8 mmHg, P = 0.0314), but diastolic BP (DBP) did not (74.4 ± 10.4 to 73.4 ± 8.5 mmHg, P = 0.5821). The decreased SBP significantly correlated with increased urinary glucose excretion (R = −0.62, P = 0.0073), but not increased urinary sodium excretion. At 6 months, SBP (118.6 ± 11.0 mmHg, P = 0.0041) and DBP (68.4 mmHg, P = 0.0363) significantly decreased. The decreased SBP significantly correlated with increased urinary sodium excretion (R = −0.60, P = 0.0014), but not increased urinary glucose excretion. Conclusions SGLT2 inhibitors significantly decreased SBP after 1 month and DBP after 6 months in obese patients with type 2 diabetes. The main mechanism of the BP-lowering effect may be plasma volume reduction by osmotic diuresis at 2 weeks and by natriuresis at 6 months after SGLT2 inhibitor administration.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors decrease blood glucose level by increasing urinary glucose excretion, and are used for the treatment of diabetes mellitus (DM). However, they are expected to have various effects in addition to blood glucose-lowering effect. The purpose of this study