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Published on: June 11, 2012
Inadequate blood glucose control is associated with in-hospital mortality and morbidity in diabetic and nondiabetic
R Ascione1, C A Rogers, C Rajakaruna
1Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
Circulation
|July 2, 2008
Summary
Poor blood glucose control (BGC) after cardiac surgery significantly increases in-hospital mortality and complications, even in non-diabetic patients. Maintaining good BGC is crucial for better patient outcomes post-surgery.
Area of Science:
- Cardiology
- Endocrinology
- Surgical Outcomes
Background:
- Postoperative hyperglycemia is common in cardiac surgery patients, affecting both diabetic and non-diabetic individuals.
- The impact of varying degrees of blood glucose control (BGC) on clinical outcomes after cardiac surgery requires further investigation.
Purpose of the Study:
- To investigate the association between different levels of postoperative blood glucose control (BGC) and clinical outcomes in adult patients undergoing cardiac surgery.
- To determine if inadequate BGC is an independent predictor of in-hospital mortality and morbidity.
Main Methods:
- Analysis of 8727 adult patients undergoing cardiac surgery between April 1996 and March 2004.
- Classification of patients into good (<200 mg/dL), moderate (200-250 mg/dL), and poor (>250 mg/dL) BGC groups based on the highest postoperative glucose level within 60 hours.
- Statistical analysis to assess the association between BGC levels, diabetes mellitus, and clinical outcomes, including in-hospital mortality, myocardial infarction, and pulmonary/renal complications.
Main Results:
- 85% of patients achieved good BGC, 10% moderate, and 4% poor BGC.
- Inadequate BGC (moderate and poor) was associated with higher rates of in-hospital mortality (9.6% for poor BGC vs. 1.8% for good BGC).
- Poor BGC independently predicted in-hospital mortality (OR 3.90), postoperative myocardial infarction (OR 2.73), and pulmonary/renal complications, particularly in patients without known diabetes.
Conclusions:
- Over 50% of patients with moderate to poor postoperative BGC were not previously diagnosed with diabetes mellitus.
- Inadequate postoperative blood glucose control is a significant predictor of in-hospital mortality and morbidity following cardiac surgery.
- Optimizing BGC in the postoperative period is critical for improving patient outcomes after cardiac surgery.
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