Introduction
Stress hyperglycaemia is common following cardiac surgery. Its optimal management
is uncertain and emerging literature suggests that flexible glycaemic control in diabetic
patients may be preferable. This study aims to assess the relationship between maximal
postoperative in-hospital blood glucose levels (BSL) and the morbidity and mortality
outcomes of diabetic and non-diabetic cardiac surgery patients.
Methods
A retrospective cohort analysis of all patients undergoing cardiac surgery at a tertiary
single centre institution from 2015 to 2019 was undertaken. Early management and outcomes
of hyperglycaemia following cardiac surgery were assessed via multivariable regression
modelling. Follow-up was assessed to 1 year postoperatively.
Results
Consecutive non-diabetic patients (n=1,050) and diabetic patients (n=689) post cardiac
surgery were included. Diabetics with peak BSL ≤13.9 mmol/L did not have an increased
risk of morbidity or mortality compared to non-diabetics with peak BSL ≤10.0 mmol/L.
In non-diabetics, stress hyperglycaemia with peak BSL >10.0 mmol/L was associated
with overall wound complications (5.7% vs 8.8%, OR 1.64 [1.00–2.69], p=0.049) and
postoperative pneumonia (2.7% vs 7.3%, OR 2.35 [1.26–4.38], p=0.007). Diabetic patients
with postoperative peak BSL >13.9 mmol/L were at an increased risk of overall wound
complication (7.4% vs 14.8%, OR 2.47 [1.46–4.16], p<0.001), graft harvest site infection
(3.7% vs 11.8%, OR 3.75 [1.92–7.30], p<0.001), and wound-related readmission (3.1%
vs 8.8%, OR 3.11 [1.49–6.47], p=0.002) when compared to diabetics with peak BSL ≤13.9
mmol/L.
Conclusion
In non-diabetics, stress hyperglycaemia with peak BSL >10.0 mmol/L is associated with
morbidity. In diabetic patients, hyperglycaemia with peak BSL ≤13.9 mmol/L was not
associated with an increased risk of morbidity or mortality compared to non-diabetics
with peak BSL ≤10.0 mmol/L. Further investigation of flexible glycaemic targets (target
BSL ≤13.9 mmol/L) in diabetic patients is warranted.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Reduction of surgical mortality and morbidity in diabetic patients undergoing cardiac surgery with a combined intravenous and subcutaneous insulin glucose management strategy.Diabetes Care. 2007; 30: 823-828
- Diabetes and coronary artery bypass surgery: an examination of perioperative glycemic control and outcomes.Diabetes Care. 2003; 26: 1518-1524
- Risk factors and impact of postoperative hyperglycemia in nondiabetic patients after cardiac surgery: a prospective study.Medicine (Baltimore). 2019; 98e15911
- Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery.J Thorac Cardiovasc Surg. 2005; 130: 1144
- Hyperglycemic episodes are associated with postoperative infections after cardiac surgery.Scand J Surg. 2018; 107: 138-144
- Beyond diabetes: saving lives with insulin in the ICU.Int J Obes Relat Metab Disord. 2002; 26: S3-S8
- Intensive insulin therapy and pentastarch resuscitation in severe sepsis.N Engl J Med. 2008; 358: 125-139
- A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study.Intensive Care Med. 2009; 35: 1738-1748
- Intensive versus conventional glucose control in critically ill patients.N Engl J Med. 2009; 360: 1283-1297
- Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial.Diabetes Care. 2015; 38: 1665-1672
- The Society of Thoracic Surgeons practice guideline series: blood glucose management during adult cardiac surgery.Ann Thorac Surg. 2009; 87: 663-669
- Stress hyperglycemia: an essential survival response.Crit Care. 2013; 17: 305
- Dysglycaemia in the critically ill and the interaction of chronic and acute glycaemia with mortality.Intensive Care Med. 2014; 40: 973-980
- Diabetic status and the relation of the three domains of glycemic control to mortality in critically ill patients: an international multicenter cohort study.Crit Care. 2013; 17: R37
- Variability of blood glucose concentration and short-term mortality in critically ill patients.Anesthesiology. 2006; 105: 244-252
- Treatment thresholds for hyperglycemia in critically ill patients with and without diabetes.Intensive Care Med. 2014; 40: 1049-1051
- Diabetes and the association of postoperative hyperglycemia with clinical and economic outcomes in cardiac surgery.Diabetes Care. 2016; 39: 408-417
- Stress-Induced hyperglycemia in diabetes: a cross-sectional analysis to explore the definition based on the Trauma Registry Data.Int J Environ Res Public Health. 2017; 14
- Hba1c, Blood pressure, and lipid control in people with diabetes: Japan Epidemiology Collaboration on Occupational Health Study.PLoS One. 2016; 11e0159071
- Stress hyperglycaemia.Lancet. 2009; 373: 1798-1807
- Gram-negative infection increases noninsulin-mediated glucose disposal.Endocrinology. 1991; 128: 645-653
- Impact of tight glycemic control on cerebral glucose metabolism after severe brain injury: a microdialysis study.Crit Care Med. 2008; 36: 3233-3238
- Glycemic variability and oxidative stress: a link between diabetes and cardiovascular disease?.Int J Mol Sci. 2014; 15: 18381-18406
Article info
Publication history
Published online: September 22, 2022
Accepted:
August 12,
2022
Received in revised form:
August 2,
2022
Received:
May 21,
2022
Identification
Copyright
© 2022 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
