Glycosylated hemoglobin levels and outcome in non-diabetic cardiac surgery patients
- PMID: 20221858
- DOI: 10.1007/s12630-010-9294-4
Glycosylated hemoglobin levels and outcome in non-diabetic cardiac surgery patients
Abstract
Purpose: In diabetics, elevated preoperative hemoglobin A1c (HbA1c) levels are associated with increased complication rates after cardiac surgery. While many non-diabetics also have elevated HbA1c, the relationship with outcome in these patients is not well understood. Therefore, in a cohort of non-diabetic patients, we tested the hypothesis that preoperative HbA1c is associated with early mortality risk after cardiac surgery.
Methods: In this retrospective observational study, we accessed data from a prospectively collected quality assurance database for a cohort of 1,474 non-diabetic elective cardiac surgery patients with documented preoperative HbA1c levels. The relationship of HbA1c with death within 30 days of surgery was examined using logistic regression modeling. Acute kidney injury and infection were similarly assessed using multivariable linear and logistic regression.
Results: Thirty-one percent of patients (n = 456) had elevated HbA1c values (>6.0%). Patients with elevated HbA1c had higher fasting and peak intraoperative blood glucose values. Also, an elevated HbA1c level was independently associated with increased 30-day mortality (odds ratio 1.53 per percent increase [1.24-1.91]; P = 0.0005). This relationship persisted even after "borderline" diabetics were excluded. Furthermore, acute kidney injury was associated with elevated baseline HbA1c (P = 0.01). No association was found between HbA1c and postoperative infection risk (P = 0.48).
Conclusion: In non-diabetics, an elevated preoperative HbA1c level (>6.0%) is independently associated with significantly greater early mortality risk after elective cardiac surgery. Our findings suggest that HbA1c may have value as a screening tool to identify high-risk non-diabetic cardiac surgery patients.
Similar articles
-
Perioperative glycemic control and postoperative complications in patients undergoing emergency general surgery: What is the role of Plasma Hemoglobin A1c?J Trauma Acute Care Surg. 2018 Jan;84(1):112-117. doi: 10.1097/TA.0000000000001724. J Trauma Acute Care Surg. 2018. PMID: 29040204
-
The Association Between Preoperative Hemoglobin A1C and Postoperative Glycemic Variability on 30-Day Major Adverse Outcomes Following Isolated Cardiac Valvular Surgery.Anesth Analg. 2017 Jan;124(1):16-22. doi: 10.1213/ANE.0000000000001715. Anesth Analg. 2017. PMID: 27861432
-
Preoperative Glycosylated Hemoglobin and Postoperative Glucose Together Predict Major Complications after Abdominal Surgery.J Am Coll Surg. 2015 Oct;221(4):854-61.e1. doi: 10.1016/j.jamcollsurg.2015.07.013. Epub 2015 Jul 20. J Am Coll Surg. 2015. PMID: 26272016
-
Systematic review of the impact of HbA1c on outcomes following surgery in patients with diabetes mellitus.Clin Nutr. 2016 Apr;35(2):308-316. doi: 10.1016/j.clnu.2015.03.007. Epub 2015 Mar 17. Clin Nutr. 2016. PMID: 25840840 Review.
-
Is there a role for HbA1c in predicting mortality and morbidity outcomes after coronary artery bypass graft surgery?Interact Cardiovasc Thorac Surg. 2013 Dec;17(6):1000-8. doi: 10.1093/icvts/ivt351. Epub 2013 Sep 10. Interact Cardiovasc Thorac Surg. 2013. PMID: 24021615 Free PMC article. Review.
Cited by
-
Preoperative Glycosylated Haemoglobin Screening to Identify Older Adult Patients with Undiagnosed Diabetes Mellitus-A Retrospective Cohort Study.J Pers Med. 2024 Feb 19;14(2):219. doi: 10.3390/jpm14020219. J Pers Med. 2024. PMID: 38392652 Free PMC article.
-
Use of pre-operative hemoglobin a1c to predict early post-operative renal failure and infection risks in patients who are not diabetics and undergoing elective off pump coronary artery bypass graft surgery.Ann Card Anaesth. 2023 Apr-Jun;26(2):160-165. doi: 10.4103/aca.aca_46_22. Ann Card Anaesth. 2023. PMID: 37706380 Free PMC article.
-
The association between hemoglobin A1c and all-cause mortality in the ICU: A cross-section study based on MIMIC-IV 2.0.Front Endocrinol (Lausanne). 2023 Feb 15;14:1124342. doi: 10.3389/fendo.2023.1124342. eCollection 2023. Front Endocrinol (Lausanne). 2023. PMID: 36875458 Free PMC article.
-
Predictive Value of Glycosylated Hemoglobin for Post-operative Acute Kidney Injury in Non-cardiac Surgery Patients.Front Med (Lausanne). 2022 Jul 11;9:886210. doi: 10.3389/fmed.2022.886210. eCollection 2022. Front Med (Lausanne). 2022. PMID: 35899215 Free PMC article.
-
A1C as a Prognosticator of Perioperative Complications of Diabetes: A Narrative Review.Turk J Anaesthesiol Reanim. 2022 Apr;50(2):79-85. doi: 10.5152/TJAR.2021.854. Turk J Anaesthesiol Reanim. 2022. PMID: 35544245 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical