Hyperglycemia or High Hemoglobin A1C: Which One is More Associated with Morbidity and Mortality after Coronary Artery Bypass Graft Surgery?

Faritous, Zahra; Ardeshiri, Maryam; Yazdanian, Forouzan; Jalali, Alireza; Totonchi, Ziae; Azarfarin, Rasoul

doi:10.5761/atcs.oa.13.02282

Cited by 35 publications

(28 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hemoglobin A 1c (HbA 1c ) is widely used as a marker of average blood glucose concentrations over the preceding 2 to 3 months and it has advantages over glucose tests [7] . Some evidence indicates that high HbA 1c levels prior to surgery are strongly associated with the severity of adverse events after CABG [8] .…”

Section: Introductionmentioning

confidence: 99%

Hemoglobin A1c Levels Predicts Acute Kidney Injury after Coronary Artery Bypass Surgery in Non-Diabetic Patients

Koçoğulları

Kunt²,

Aksoy

et al. 2017

Braz J Cardiovasc Surg

View full text Add to dashboard Cite

Introduction Elevated hemoglobin A1c levels in patients with diabetes mellitus have been known as a risk factor for acute kidney injury after coronary artery bypass grafting. However, the relationship between hemoglobin A1c levels in non-diabetics and acute kidney injury is under debate. We aimed to investigate the association of preoperative hemoglobin A1c levels with acute kidney injury in non-diabetic patients undergoing isolated coronary artery bypass grafting.Methods202 non-diabetic patients with normal renal function (serum creatinine <1.4 mg/dl) who underwent isolated coronary bypass were analyzed. Hemoglobin A1c level was measured at the baseline examination. Patients were separated into two groups according to preoperative Hemoglobin A1c level. Group 1 consisted of patients with preoperative HbA1c levels of < 5.6% and Group 2 consisted of patients with preoperative HbA1c levels of ≥ 5.6%. Acute kidney injury diagnosis was made by comparing baseline and postoperative serum creatinine to determine the presence of predefined significant change based on the Kidney Disease Improving Global Outcomes (KDIGO) definition.ResultsAcute kidney injury occurred in 19 (10.5%) patients after surgery. The incidence of acute kidney injury was 3.6% in Group 1 and 16.7% in Group 2. Elevated baseline hemoglobin A1c level was found to be associated with acute kidney injury (P=0.0001). None of the patients became hemodialysis dependent. The cut off value for acute kidney injury in our group of patients was 5.75%.ConclusionOur findings suggest that, in non-diabetics, elevated preoperative hemoglobin A1c level may be associated with acute kidney injury in patients undergoing coronary artery bypass grafting. Prospective randomized studies in larger groups are needed to confirm these results.

show abstract

Section: Introductionmentioning

confidence: 99%

Hemoglobin A1c Levels Predicts Acute Kidney Injury after Coronary Artery Bypass Surgery in Non-Diabetic Patients

Koçoğulları

Kunt²,

Aksoy

et al. 2017

Braz J Cardiovasc Surg

View full text Add to dashboard Cite

show abstract

“…19 While elevated HbA1c is common among hospitalized patients, it has not been clearly established that this is predictive of postoperative hyperglycemia in patients undergoing non-cardiac surgery. 19,20 Recent studies of abdominal surgery suggest that elevated HbA1c is associated with major cardiac complications, while hyperglycemia is more likely to be associated with SSI, emphasizing the importance of identifying both of these risk factors. 2,14 If this were indeed the case, widespread HbA1c screening and postoperative glucose testing would each identify different types of high-risk patients to target for intervention strategies.…”

Section: Résumémentioning

confidence: 99%

Postoperative dysglycemia in elective non-diabetic surgical patients: a prospective observational study

Yang

Jaeger

Baxter

et al. 2016

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose Elevated glycosylated hemoglobin (HbA1c) is often found in surgical patients with no history of diabetes. The purpose of this prospective observational study was to determine if elevated preoperative HbA1c is associated with postoperative hyperglycemia in non-diabetic surgical patients and to identify predictors of elevated HbA1c. Methods This study included 257 non-diabetic adults scheduled for inpatient surgery. Preoperatively, capillary blood glucose (CBG) and HbA1c were measured and patients completed the Canadian Diabetes Risk Questionnaire (CANRISK). Capillary blood glucose was measured for two days or until hospital discharge at the following time points: postoperatively, before all meals, and at 22:00 hr. The mean CBG and incidence of hyperglycemia were compared between HbA1c levels: Group I \ 6.0%, Group II 6.0-6.4%, and Group III C 6.5%. ResultsThe mean postoperative glucose levels at all time points were significantly higher in Group III compared with Groups I and II (P \ 0.01). At least one episode of hyperglycemia (CBG C 10.0 mMolÁL -1 ) occurred in 61% (11/18) of patients in Group III vs 11% (23/209) of patients in Group I (relative risk, 5.55; 95% confidence interval [CI], 3.26 to 9.47; P \ 0.001). Elevated glycosylated hemoglobin C 6.0% was found in 31% (33/107) of those with a high CANRISK score. The best predictors of postoperative hyperglycemia were preoperative CBG [ 6.9 mMolÁL -1 [diagnostic odds ratio (OR) (reference\6.0 mMolÁL -1 ), 4.16; 95% CI, 1.57 to 10.98; P = 0.004], HbA1c C 6.0% [OR (reference \ 6.0%), 3.00; 95% CI, 1.39 to 6.49; P = 0.005], and HbA1c C 6.5% [OR (reference \ 6.5%), 13.45; 95% CI, 4.78 to 37.84; P \0.001]. Conclusions Elevated HbA1c is associated with higher mean postoperative glucose levels in patients with no diabetic history. The CANRISK score is a strong predictor of elevated HbA1c, while CBG and HbA1c are both predictors of postoperative hyperglycemia. RésuméObjectif Une hémoglobine glycosylée (HbA1c) élevée est souvent observée chez des patients chirurgicaux sans antécédents de diabète. L'objectif de cette étude observationnelle prospective était de déterminer si une HbA1c préopératoire élevée est associée à une hyperglycémie post opératoire chez des patients chirurgicaux non diabétiques et d'identifier les facteurs prédictifs d'une HbA1c élevée. Méthodes Cette étude a inclus 257 adultes non diabétiques devant être hospitalisés pour chirurgie. La glycémie capillaire (CBG) et l'HbA1c ont été mesurées en

show abstract

“…During 120 days of erythrocyte lifespan, the rate of glycosylation of hemoglobin increases in parallel with the blood glucose levels. The HbA1c test measures the rate of glycosylation; therefore, HbA1c provides information about the blood glucose profile belonging to the erythrocyte lifespan, which is past 2-3 months [5,6]. The assessment of HbA1c level should be carried out using certified analytical methods recommended by the National Glycohemoglobin Standardization Program (NGSP), American (ADA) and European (EASD) Diabetes Associations [7].…”

Section: Introductionmentioning

confidence: 99%

“…Considering these high rates, mortality and postoperative complications should have been expected to be very high postoperatively. After the studies on HbA1c, which is reported to strongly predict mortality, publications suggesting that high HbA1c can predict postoperative adverse events but cannot reveal any presumption related to mortality started to become evident in the literature [6,10]. Moreover, it is even controversial whether or not high HbA1c levels are a good biomarker for the development of diabetes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Tracing the Proposed Adverse Effects of Higher Values of Glycosylated Hemoglobin (HbA1c) in Tightly-Controlled Diabetic Patients Undergoing Primary CABG

Elsayed¹,

Eid²

2019

IJCTS

View full text Add to dashboard Cite

Objectives:The rising percentage of patients scheduled for primary CABG with HbA1c>8.6% is alarming reflecting higher burden on the patient, operative procedure and the operating surgeon. Although some articles in the literature argue that decompensated diabetes increases mortality and morbidity, other studies are arguing that there is no relation between them. This study aims at tracing the occurrence of the proposed adverse complications after primary CABG operations related to HbA1c values>8.6% in diabetics subjected to tight glycemic control; in a trial to conclude how far the value of HbA1c could be accepted to carry out the surgery safely. Methods:This prospective study included 80 adult diabetic patients who presented with IHD requiring primary CABG. It was conducted between January 2016 and December 2018. Group (I) included 42 patients with HbA1c values<8.6% and group (II) included 38 patients with HbA1c values>8.6%. We compared the following: perioperative MI, low cardiac output syndrome, operative mortality, rhythmic complications, hemorrhagic complications, respiratory complications, cerebrovascular accidents, acute renal failure development, superficial and deep surgical wounds infections, overall hospital complications and overall one-year mortality and survival. Results: Mean HbA1c% value was 7.5 ± 1.11% for group (I) and 9.3 ± 1.03% for group (II). Prior to surgery, the mean FBG level was 136.9±41.7 mg/dl for group (I) and 152.2±27.3 mg/dl for group (II) with tight glycemic control measures. Although group (II) showed higher values in the studied parameters (pre-, intra-and post-operatively), no statistically significant differences appeared between the two subsets of patients regarding the proposed adverse complications. The overall hospital complication rate was 13(30.95%) and 14(36.84%) for group (I) and (II) respectively (p>0.05). In the follow-up period, both groups expressed comparable results with no statistical significance. The overall one-year survival was 95.23% and 94.73% in group (I) and (II) respectively (p>0.05) and the overall mortality was 5% (two deaths from each group) (p>0.05). Conclusion:Although patients with IHD undergoing primary CABG and having decompensated diabetes with HbA1c values>8.6% have more insulted cardiovascular condition, these higher HbA1c values do not add more additional impact on the proposed adverse intra-and postoperative complications as with lower values with the aid of strict (tight) glycemic control measures in the immediate preoperative period.

show abstract

Hyperglycemia or High Hemoglobin A1C: Which One is More Associated with Morbidity and Mortality after Coronary Artery Bypass Graft Surgery?

Cited by 35 publications

References 16 publications

Hemoglobin A1c Levels Predicts Acute Kidney Injury after Coronary Artery Bypass Surgery in Non-Diabetic Patients

Hemoglobin A1c Levels Predicts Acute Kidney Injury after Coronary Artery Bypass Surgery in Non-Diabetic Patients

Postoperative dysglycemia in elective non-diabetic surgical patients: a prospective observational study

Tracing the Proposed Adverse Effects of Higher Values of Glycosylated Hemoglobin (HbA1c) in Tightly-Controlled Diabetic Patients Undergoing Primary CABG

Contact Info

Product

Resources

About