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Effect of CPB glucose levels on inflammatory response after pediatric cardiac surgery
Zhi-Hua Zeng1, Xin-Yi Yu1, Xiao-Cheng Liu1
1Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, No.61, the 3rd Ave, TEDA, Tianjin, 300457, China.
Insights
Maintaining optimal cardiopulmonary bypass (CPB) glucose levels below 8.1 mmol/L is crucial for reducing severe systemic inflammatory response syndrome (SIRS) after pediatric cardiac surgery. This finding helps improve patient outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Intensive Care Medicine
- Inflammatory Response
Background:
- Systemic inflammatory response syndrome (SIRS) is a frequent complication following cardiac surgery.
- Optimal glycemic thresholds for pediatric patients undergoing open-heart surgery with cardiopulmonary bypass (CPB) remain undefined.
- This study investigates the ideal CPB glucose level in pediatric cardiac surgery patients.
Purpose of the Study:
- To determine the optimal glucose threshold during cardiopulmonary bypass (CPB) associated with severe systemic inflammatory response syndrome (SIRS) in pediatric cardiac surgery patients.
- To analyze the relationship between CPB glucose levels and the incidence of severe SIRS.
- To establish evidence-based glycemic management guidelines for pediatric cardiac surgery.
Main Methods:
- Retrospective analysis of 7350 pediatric patients with congenital heart disease undergoing cardiac surgery with CPB (June 2012 - December 2020).
- Primary outcome: severe SIRS.
- Two-piece-wise regression model to assess the threshold effect of CPB glucose on severe SIRS, adjusting for confounders.
Main Results:
- A non-linear relationship was observed between CPB glucose and severe SIRS, with a turning point at 8.1 mmol/L.
- Glucose levels below 8.1 mmol/L showed no increased risk of severe SIRS.
- Elevated CPB glucose (> 8.1 mmol/L) was associated with a 1.35-fold increased odds of severe SIRS (95% CI 1.21, 1.50).
Conclusions:
- CPB glucose levels are significantly associated with the inflammatory response post-pediatric cardiac surgery.
- Optimal outcomes are suggested with CPB glucose levels not exceeding 8.1 mmol/L.
- This finding supports the implementation of stricter glycemic control during CPB in pediatric cardiac surgery.
Background:
Systemic inflammatory response syndrome (SIRS) is a common complication after cardiac surgery. There are no definite optimal glycemic threshold for pediatric patients receiving open-heart surgery with CPB. The study aimed to investigate the optimal cardiopulmonary bypass (CPB) glucose in patients undergoing cardiac surgery.
Methods:
We enrolled children with congenital heart disease who underwent surgical repair between June 2012 and December 2020. We included only patients who underwent cardiac surgery with CPB. The primary outcome was severe SIRS. A two-piece-wise regression model was applied to examine threshold effect of CPB glucose on severe SIRS.
Results:
A total of 7350 patients were enrolled in the present study, of whom 3895 (52.99%) are female. After potential confounders were adjusted, non-linear relationship was detected between CPB glucose and severe SIRS, whose turning point was 8.1. With CPB glucose < 8.1 mmol/L, the estimated dose-response curve was consistent with a horizontal line. However, the prevalence of severe SIRS increased with increasing glucose up to the turning point (Glucose > 8.1 mmol/L); the odds ratio (OR) of the Glucose was 1.35 (95% CI 1.21, 1.50).
Conclusions:
The present study indicates the association of CPB glucose with inflammatory response after pediatric cardiac surgery. The patients might have the best outcomes with the optimal CPB glucose no more than 8.1 mmol/L.
