Glycated hemoglobin HbA 1c – a new risk marker for the outcome of cardiac surgery?

Abstract

IntroductionAbout 30% of patients undergoing cardiac surgery are diabetic, and glycated hemoglobin (HbA1c) is a reliable marker for long-term glucose control. The aim of our study was to examine whether tight glucose control before a cardiac operation results in a better outcome of the surgical treatment.Material and methodsWe performed a retrospective record review of 350 diabetic patients undergoing cardiac surgery in our institution. Preoperative glycemia control was assessed by measurement of the glycated hemoglobin level. The patient population was divided into three groups: group I – patients with HbA1c below 7% (n = 195); group II – patients with HbA1c between 7% and 8% (n = 88); and group III – patients with HbA1c above 8% (n = 67).ResultsThe demographic data and operating risk in all groups of patients were similar. There were 2 deaths (1.02%) in group I, 2 deaths (2.27%, p = 0.78) in group II and 3 deaths (4.47%, p = 0.20) in group III. Cardiac accidents occurred in 9 patients (4.60%) from group I, 7 patients (7.95%, p = 0.20) from group II, and in 6 patients (9.05%, p = 0.40) from group III. Cerebrovascular accidents (CVA) occurred in 7 (3.58%), 5 (5.68%, p = 0.67) and 5 (7.46%, p = 0.61) patients, respectively. Acute renal dysfunction requiring renal replacement therapy occurred in 4 patients from group I (2.05%), 3 patients from group II (3.40%, p = 0.78) and 4 patients from group III (5.97%, p = 0.23).ConclusionsA large percentage of diabetic patients referred for cardiac operations have poorly controlled glycemia. Optimal preoperative glycemia control results in lower postoperative mortality and morbidity. In addition, the preoperative HbA1c level is a good indicator of the risk of postoperative complications in diabetic patients undergoing cardiac operations.

Effects of Preoperative HbA1c Levels on the Postoperative Outcomes of Coronary Artery Disease Surgical Treatment in Patients with Diabetes Mellitus and Nondiabetic Patients: A Systematic Review and Meta-Analysis

“…Most of the included studies did not report on the independent blind assessment of outcomes. In terms of follow-up, 9 studies [23,24,26,28,31,36,37,42,43] did not report follow-up time and one study [41] had a 30-day follow-up, which was relatively short for outcomes and had high bias. Other studies were at low risk of bias in other items (see Table 2).…”

“…Stroke. Ten studies reported on the incidence of stroke [24,26,29,31,[39][40][41][42][43][44]. The results of the meta-analysis showed that there was no significant difference in stroke incidence between diabetic patients with lower preoperative HbA1c levels and those with higher preoperative HbA1c levels after cardiac surgery (OR = 1:49, 95% CI 0.94-2.37, P = 0:37, and I 2 = 8%), as shown in Figure 4.…”

“…Renal Failure. Nine studies reported on the incidence of renal failure [24,28,31,35,39,40,[42][43][44]. The results of the meta-analysis suggested that a higher preoperative HbA1c level was associated with a high risk of renal failure after cardiac surgery (OR = 1:63, 95% CI 1.13-2.33, P = 0:63, and I 2 = 0%) (Annex 3-1).…”

The role of nuts consumption in the primary and secondary prevention of type 2 diabetes

“…However, in the process of disease progress monitoring there is an additional index applied -HbA 1c , which enables to reflect the glycaemic state up to three months back, which is linked to the period of the erythrocyte life cycle (8-12 weeks) [4,27].…”

Glycated Hb levels and its effect on outcomes in Cardiac Surgery

“…The evidence on the effect of HbA1c levels on mortality is contradictory with some studies reporting that increased HbA1c levels are associated with increased mortality [18][19][20][21][22][23][24][25] . But by in large, most studies seem to show that increased HbA1c is not predictive of increased mortality as solo indicator [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] . The findings from all these studies are summarised in Table 1 and Table 2.…”