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Published on: March 27, 2018
Association between HbA1c and deep sternal wound infection after coronary artery bypass: a systematic review and
Wenyu Zhao1, Jingui Xie2,3, Zhichao Zheng4
1School of Management, University of Science and Technology of China, Hefei, China.
Insights
Elevated glycated hemoglobin (HbA1c) levels above 5.7% are linked to increased deep sternal wound infection (DSWI) risk after coronary artery bypass grafting (CABG). This risk escalates with higher HbA1c, particularly in diabetic patients.
Area of Science:
- Cardiovascular Surgery
- Metabolic Health
- Infectious Disease Epidemiology
Background:
- Deep sternal wound infection (DSWI) is a significant complication following coronary artery bypass grafting (CABG).
- Glycated hemoglobin (HbA1c) is a key indicator of long-term glycemic control.
Conclusions:
- Preoperative HbA1c levels greater than 5.7% are associated with a higher risk of DSWI after CABG, with risk progression correlating to HbA1c levels.
- The association between HbA1c and DSWI risk was significant in diabetic patients but not in non-diabetic individuals.
Background:
Deep sternal wound infection (DSWI) constitutes a serious complication after coronary artery bypass grafting (CABG) surgery. The aim of this study is to evaluate the dose-response relationship between glycated hemoglobin (HbA1c) level and the risk of DSWI after CABG.
Methods:
PubMed, Scopus, and Cochrane Library databases were searched to identify potentially relevant articles. According to rigorous inclusion and exclusion criteria, fourteen studies including 15,570 patients were enrolled in our meta-analysis. Odds ratio (OR) with 95% confidence intervals (CIs) was used as the summary statistic. The robust-error meta-regression model was used to synthesize the dose-response relationship.
Results:
Our meta-analysis shows that among patients undergoing CABG, preoperative elevated HbA1c was associated with the risk of developing DSWI (OR = 2.67, 95% CI 2.00-3.58) but with low prognostic accuracy (diagnostic OR = 2.70, 95% CI 1.96-3.73; area under the curve = 0.66, 95% CI 0.62-0.70) for predicting postoperative DSWI. Subgroup analyses showed the relationship became nonsignificant in patients without diabetes and studies adopting lower HbA1c thresholds. Dose-response analysis showed a significant nonlinear (p = 0.03) relationship between HbA1c and DSWI, with a significantly increased risk of DSWI when HbA1c was > 5.7%.
Conclusions:
An elevated HbA1c level of > 5.7% was related to a higher risk of developing DSWI after CABG, and the risk increased as the HbA1c level grew. The association between HbA1c and DSWI was nonsignificant among nondiabetic patients while significant among diabetic patients.
