Impact of admission serum glucose level on in-hospital outcomes following coronary artery bypass grafting surgery

Abstract

I t has been confirmed that serum glucose (SG) levels are independently associated with both short-and long-term outcomes of patients with cardiovascular disease (1). In the setting of an acute myocardial infarction, hyperglycemia enhances the risk of morbidity and mortality independent of the patients' diabetes status (2). Hyperglycemia is also highly predictive of the occurrence of left ventricular failure and cardiac death in patients with acute coronary syndrome (3,4), and is associated with larger infarct size, worse functional recovery and higher long-term mortality in patients undergoing reperfusion with either thrombolysis or percutaneous coronary intervention (5,6).In patients undergoing cardiac surgery, there is also evidence that both intraoperative (7,8) and postoperative (9) SG levels predict the occurrence of adverse postoperative events. Tight control of intra-and postoperative SG levels with insulin increases survival and decreases the incidence of ischemic events in diabetic patients undergoing coronary artery bypass grafting (CABG) surgery (10).In contrast to the known importance of intra-and/or postoperative SG levels on the outcomes of CABG surgery, there exists a paucity of data regarding the potential impact of preoperative or admission SG level on the outcomes of cardiac surgery. We hypothesized that an elevated preoperative or admission SG level would be an independent clInIcal studIes ©2010 Pulsus Group Inc. All rights reserved OBJECTIVE:The impact of admission serum glucose (SG) level on outcomes in coronary artery bypass grafting (CABG) surgery is unknown. The present study sought to determine whether elevated admission SG level is associated with adverse outcomes following CABG surgery. METHODS: Patients undergoing CABG surgery between January 2000and December 2005 at a single centre were identified (n=2856). Admission SG levels of less than 9.2 mmol/L and 9.2 mmol/L or greater were chosen to divide patients into two groups based on the 75th percentile of SG distribution. A logistic regression model was generated to determine the impact of admission SG level on a composite outcome of any one or more of in-hospital mortality, stroke, perioperative myocardial infarction, sepsis, deep sternal wound infection, renal failure, requirement for postoperative inotropes and prolonged ventilation. RESULTS: In total, 76.3% of patients had an admission SG level of less than 9.2 mmol/L (group A) and 23.7% had an admission SG level of 9.2 mmol/L or greater (group B). Group B patients were more likely to be female, have diabetes, have preoperative renal failure, have an ejection fraction of less than 40%, experience myocardial infarction within 21 days before surgery, and have triple vessel or left main disease (P<0.05). Univariate analysis revealed no difference in in-hospital mortality between group A (2.2%) and group B (3.2%) (P=0.12); however, the composite outcome was more likely to occur in group B (40.8%) versus group A (27.9%) (P=0.0001). After multivariable adjustment, admission SG level of...

Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral Nutrition

“…25,31 Hyperglycemia has been associated with a high incidence of postoperative infections in both the pediatric and adult cardiac surgery population. 32,33 Increasing blood glucose concentrations have been shown to dampen innate immunologic processes. 34 In contrast to findings in our unpublished adult study, elevated blood glucose levels were not identified as potential risk factors for developing BSI in this cohort of children on HPN.…”

Association of preoperative glucose concentration with myocardial injury and death after non-cardiac surgery (GlucoVISION): a prospective cohort study

“…1 Although the mechanisms remain unclear, glucose concentrations show a continuous relation with future cardiovascular disease in patients with or without diabetes and in the general population, beginning at concentrations well below those used to define diabetes. 1 These associations have been observed in ambulatory settings 1 and special ised hospital settings; [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] however, the relation between preoperative glucose concentration and morbidity in patients undergoing a broad range of noncardiac surgeries has not been systematically studied in large numbers of patients.…”

Impact of hyperglycemia on perioperative mortality after coronary artery bypass graft surgery

“…Admission blood glucose levels were associated with significant morbidity after CABG surgery. 22 Our analyses indicated that there is a gradual increase in risk relative to blood glucose levels, regardless of the administration of insulin.…”