Intraoperative Changes in Blood Glucose Levels Increase the Risk of Death in Cardiac Surgery

2006 ◽  
Vol 31 (03) ◽  
Author(s):  
H Hager ◽  
E Giorni ◽  
A Felli ◽  
B Mora ◽  
M Hiesmayr ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Glucose ◽  
Glucose Levels ◽  
Risk Of Death ◽  
Blood Glucose Levels

scholarly journals Hyperglycemic Episodes Are Associated With Postoperative Infections After Cardiac Surgery

2017 ◽  
Vol 107 (2) ◽  
pp. 138-144 ◽  
Author(s):  
K. M. Järvelä ◽  
N. K. Khan ◽  
E. L. Loisa ◽  
J. A. Sutinen ◽  
J. O. Laurikka ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Glucose ◽  
Surgical Site Infections ◽  
Infectious Complications ◽  
Target Range ◽  
Deep Sternal Wound Infection ◽  
Postoperative Infections ◽  
Glucose Levels ◽  
Arterial Blood ◽  
Blood Glucose Levels

Background and Aims: To describe the incidence of and risk factors for postoperative infections and the correlation between postoperative hyperglycemia despite tight blood glucose control with infectious and other complications after contemporary cardiac surgery. Material and Methods: The study comprised 1356 consecutive adult patients who underwent cardiac surgery between January 2013 and December 2014 and were followed up for 6 months. Patients surviving the first 2 days were included in the analysis. Preoperative demographic information, medical history, procedural details, and the postoperative course were recorded. The target range for blood glucose levels was 4–7 mmol/L and repeated arterial blood samples were obtained during the intensive care unit stay. The associations of blood glucose levels during the first postoperative day and the occurrence of postoperative infections and other significant complications were analyzed. Results: Of the study cohort, 9.8% developed infectious complications which were classified as major surgical site infections in 2.2%, minor surgical site infections in 1.1%, lung infections in 2.0%, unclear fever or bacteremia in 0.3%, cannula or catheter related in 2.6%, multiple in 1.5%, and other in 0.2%. The incidence of deep sternal wound infection was 2.0%. Repeated hyperglycemia occurred in 39.7% of patients and was associated with increased rates of postoperative infections, 12.1% versus 8.2%, p = 0.019; stroke, 4.9% versus 1.5%, p < 0.001; and mortality, 6.1% versus 2.1%, p < 0.001, when compared to patients with single or no hyperglycemia. Conclusion: Every 10th patient develops infectious complications after cardiac surgery. Repeated hyperglycemia is associated with increased rates of infectious complications, stroke, and mortality.

scholarly journals Risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252209
Author(s):  
Giuseppe Filiberto Serraino ◽  
Michele Provenzano ◽  
Federica Jiritano ◽  
Ashour Michael ◽  
Nicola Ielapi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Blood Glucose ◽  
Kidney Injury ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Risk Patients

Background Acute Kidney Injury (AKI) represents a clinical condition with poor prognosis. The incidence of AKI in hospitalized patients was about 22–57%. Patients undergoing cardiac surgery (CS) are particularly exposed to AKI because of the related oxidative stress, inflammation and ischemia-reperfusion damage. Hence, the risk profile of patients undergoing CS who develop AKI and who are consequently at increased mortality risk deserves further investigation. Methods We designed a retrospective study examining consecutive patients undergoing any type of open-heart surgery from January to December 2018. Patients with a history of AKI were excluded. AKI was diagnosed according to KDIGO criteria. Univariate associations between clinical variables and AKI were tested using logistic regression analysis. Variable thresholds maximizing the association with AKI were measured with the Youden index. Multivariable logistic regression analysis was performed to assess predictors of AKI through backward selection. Mortality risk factors were assessed through the Cox proportional hazard model. Results We studied 158 patients (mean age 51.2±9.7 years) of which 74.7% were males. Types of procedures performed were: isolated coronary artery bypass (CABG, 50.6%), valve (28.5%), aortic (3.2%) and combined (17.7%) surgery. Overall, incidence of AKI was 34.2%. At multivariable analysis, young age (p = 0.016), low blood glucose levels (p = 0.028), estimated Glomerular Filtration Rate (p = 0.007), pH (p = 0.008), type of intervention (p = 0.031), prolonged extracorporeal circulation (ECC, p = 0.028) and cross-clamp (p = 0.021) times were associated with AKI. The threshold for detecting AKI were 91 and 51 minutes for ECC and cross-clamp times, respectively. At survival analysis, the presence of AKI, prolonged ECC and cross-clamp times, and low blood glucose levels forecasted mortality. Conclusions AKI is common among CS patients and associates with shortened life-expectancy. Several pre-operative and intra-operative predictors are associated with AKI and future mortality. Future studies, aiming at improving prognosis in high-risk patients, by a stricter control of these factors, are awaited.

scholarly journals Inflammation but not Glycemic Control is Associated with Neurocognitive Decline After Cardiac Surgery

2021 ◽  
Author(s):  
Laura Scrimgeour ◽  
Ian Ikeda ◽  
Nicholas Sellke ◽  
Guangbin Shi ◽  
Jun Feng ◽  
...  
Keyword(s):  
Gene Expression ◽  
Cardiac Surgery ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Transcriptome Analysis ◽  
Neurocognitive Function ◽  
Human Transcriptome ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Neurocognitive Decline

Background: Whether perioperative glycemic control or markers of inflammation is associated with neurocognitive decline (NCD) after cardiac surgery was examined. Methods: Thirty patients undergoing cardiac surgery utilizing cardiopulmonary bypass (CPB) were screened for NCD preoperatively and on post-operative day four (POD4). Serum cytokine levels were measured and human transcriptome analysis was performed on blood samples. Neurocognitive data are presented as a change from baseline to POD4 in a score standardized with respect to age and gender. Results: A decline in neurocognitive function was identified in 73% (22/30) of patients on POD4. Patients with postoperative leukocytosis (WBC ≥ 10.5) had more NCD when compared to their baseline function (p=0.03). Patients with elevated IL-8 levels at 6 hours postoperatively had a significant decline in NCD at POD4 (p=0.04). Surprisingly, TNF-α, IL-1β, IL-2, or IL-6 levels were not associated with NCD (p>0.3 for all). There was no difference in neurocognitive function between patients with elevated HbA1c levels preoperatively (p=0.973) or elevated fasting blood glucose levels the morning of surgery (>126mg/dL, p=0.910), or a higher maximum blood glucose levels during CPB (>180mg/dL, p=0.252), or higher average glucose levels during CPB (>160mg/dL, p=0.639). Human transcriptome analysis demonstrated unique and differential patterns of gene expression in patients depending on the presence of DM and NCD. Conclusions: Perioperative glycemic control does not have an effect on NCD soon after cardiac surgery. Postoperative leukocytosis and elevated IL-8 levels are associated with neurocognitive decline. The profile of gene expression was altered in patients with NCD with or without diabetes.

scholarly journals Perioperative Blood Glucose Levels <150 mg/dL are Associated With Improved 5-Year Survival in Patients Undergoing On-Pump Cardiac Surgery

Medicine ◽  
2015 ◽  
Vol 94 (45) ◽  
pp. e2035 ◽  
Author(s):  
Ashham Mansur ◽  
Aron Frederik Popov ◽  
Ameen Abu Hanna ◽  
Ingo Bergmann ◽  
Ivo Florian Brandes ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels
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