Intensive Care Unit Hyperglycemia After Cardiac Surgery: Risk Factors and Clinical Outcomes

Area of Science:

• Cardiology
• Intensive Care Medicine
• Endocrinology

Background:

• Hyperglycemia following cardiac surgery is a significant concern, associated with increased patient morbidity and mortality.
• Understanding the incidence, risk factors, and clinical impact of postoperative hyperglycemia is crucial for improving patient care in the cardiac surgery intensive care unit (CSICU).

Purpose of the Study:

• To determine the incidence of hyperglycemia in patients after cardiac surgery.
• To identify independent risk factors associated with postoperative hyperglycemia.
• To evaluate the association between hyperglycemia and clinical outcomes in the CSICU.

Main Methods:

• A prospective, observational study was conducted involving 210 consecutive cardiac surgery patients admitted to the CSICU.
• Blood glucose levels were monitored regularly for up to 7 days post-surgery or until discharge.
• Perioperative risk factors and clinical outcomes, including acute kidney injury and mechanical ventilation duration, were assessed.

Main Results:

• Postoperative hyperglycemia (glucose ≥180 mg/dL) was observed in 30% of patients.
• Independent risk factors for hyperglycemia included diabetes mellitus (OR 6.73), elevated white blood cell count (OR 1.28), and high EuroSCORE II (OR 1.20).
• Hyperglycemic patients experienced higher rates of acute kidney injury (34.9% vs 18.9%), longer mechanical ventilation (959 vs 720 min), increased ICU-acquired weakness (14% vs 5.5%), and more multiorgan failure (6.3% vs 0.7%).

Conclusions:

• Hyperglycemia is common in the immediate postoperative period after cardiac surgery.
• Diabetes, high EuroSCORE II, and preoperative leukocytosis are significant independent risk factors for developing hyperglycemia.
• Postoperative hyperglycemia is associated with adverse clinical outcomes, including increased acute kidney injury, prolonged mechanical ventilation, and higher incidence of ICU-acquired weakness and multiorgan failure.