Impact of preoperative glycometabolic status on outcomes in cardiac surgery: Systematic review and meta-analysis

Abstract

Background: Historically, impaired glucose metabolism has been associated with early and late complicated clinical outcomes after cardiac surgery; however, such a condition is not specific to subjects with diabetes mellitus and involves a larger patient population.Methods: Databases were screened (January 2000 to December 2020) to identify eligible articles; studies that evaluated the association between preoperative metabolic status, as assessed by glycosylated hemoglobin levels and clinical outcomes, were considered. The studies were stratified in thresholds by baseline glycosylated hemoglobin level (lower vs higher).Results: Thirty studies, involving 34,650 patients, were included in the review. In a meta-analysis stratified by glycosylated hemoglobin levels, early mortality was numerically reduced in each threshold comparison and yielded the highest reductions when less than 5.5% versus greater than 5.5% glycosylated hemoglobin levels were compared (risk ratio, 0.39; 95% confidence interval, 0.18-0.84; P ¼ .02). Comparing higher glycosylated hemoglobin threshold values yielded comparable results. Late mortality was reduced with lower levels of glycosylated hemoglobin. Low preoperative glycosylated hemoglobin was associated with the lowest risk of sternal wound infections (risk ratio, 0.50; 95% confidence interval, 0.32-0.80; P ¼ .003 and risk ratio, 0.53; 95% confidence interval, 0.39-0.70; P < .0001) for comparisons of less than 7.5% versus greater than 7.5% and less than 7.0% versus greater than 7.0% glycosylated hemoglobin thresholds, respectively. Additionally, levels of glycosylated hemoglobin lower than 7% were associated with reduced hospital stay, lower risk of stroke/transient ischemic attack (risk ratio 0.53; 95% confidence interval, 0.39-0.70; P < .0001), and acute kidney injury (risk ratio, 0.65; 95% confidence interval, 0.54-0.79; P < .0001).Conclusions: Lower levels of glycosylated hemoglobin in patients undergoing cardiac surgery are associated with a lower risk of early and late mortality, as well as in the incidence of postoperative acute kidney injury, neurologic complications, and wound infection, compared with higher levels.

Construction and validation of a nomogram for predicting survival in elderly patients with cardiac surgery

“…Interestingly, dysregulated blood glucose metabolism has been linked to adverse clinical outcomes after cardiac surgery (24). In this respect, fluctuating blood sugar levels have been…”

“…Interestingly, dysregulated blood glucose metabolism has been linked to adverse clinical outcomes after cardiac surgery ( 24 ). In this respect, fluctuating blood sugar levels have been linked to an elevated risk of postoperative complications and lower survival rates after CABG ( 25 ).…”

Impact of diabetes mellitus on long-term clinical and graft outcomes after off-pump coronary artery bypass grafting with pure bilateral skeletonized internal thoracic artery grafts

“…HbA1c, which reflects the mean glycemia over the previous 8–12 weeks [ 33 , 34 ], has been investigated as a parameter exerting an adverse influence on outcomes in patients with DM who underwent cardiac surgery [ 10 , 11 ]. In this study, postoperative wound infection, which is the major drawback of using bilateral ITA grafts for CABG in patients with DM, was significantly lower in the well-controlled DM group, although without differences regarding cardiac mortality and MACE between the well-controlled and poorly controlled DM groups.…”

“…Postoperative sternal wound infection is one of the most worrisome complications after CABG using BITA. Preoperative hemoglobin A1c (HbA1c) has been studied as a prognostic factor for postoperative wound infection in patients with DM who underwent cardiac surgery [ 10 , 11 ]. The effect of HbA1c on postoperative morbidities, including mediastinal wound infection, was tried to define in this homogenous cohort.…”

Akutes Nierenversagen

“…In dieser Gruppe von Betroffenen ist der Diabetes zudem ein negativer Prädiktor für die Überlebensrate im 1. und nach 3 Jahren [ 12 , 15 ]. Bei geplanten Herzoperationen ist ein HbA 1c -Wert unter 7 % bei Menschen mit Diabetes mit einer erniedrigten Inzidenz einer akuten Nierenschädigung assoziiert [ 3 ]. Nierentransplantierte mit Diabetes mellitus Typ 2 haben bei geplanten operativen Eingriffen insgesamt ein erhöhtes Risiko, insbesondere auch für ein akutes Nierenversagen [ 16 ].…”