Related Experiment Video
Updated: Jun 27, 2025
Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Leucoglycemic index predicts post-operative vasopressor-inotropic requirement after adult cardiac surgery
Rohan Magoon1, Armaanjeet Singh1, Ramesh Kashav1
1Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Insights
Intensive care unit (ICU) admission leucoglycemic index (LGI) can predict the need for vasopressor-inotropic support after cardiac surgery. An LGI above 1484.75 indicates a higher likelihood of requiring significant post-operative support.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Biomarkers
Background:
- Cardiac surgery frequently requires substantial post-operative vasoactive-inotropic support.
- The leucoglycemic index (LGI), calculated from serum glucose and total leucocyte count, has shown prognostic potential.
Purpose of the Study:
- To determine if ICU-admission LGI can predict the need for post-operative vasopressor-inotropic support in patients undergoing cardiac surgery on cardiopulmonary bypass (CPB).
Main Methods:
- Retrospective review of 2138 cardiac surgery patients (January 2015 - December 2020).
- Vasopressor-inotropic requirement assessed using vasoactive-inotropic score (VIS) and indexed VIS (VISi) over 72 hours post-operation.
- Patients categorized into high (h-VISi ≥3) and low (l-VISi <3) support groups.
Main Results:
- Multivariate analysis identified LGI (OR: 1.09), prior congestive heart failure, CPB duration, aortic cross-clamp time, and EuroSCORE II as independent predictors of high vasopressor-inotropic support.
- An LGI cutoff of 1484.75 predicted high VISi (≥3).
- Elevated LGI correlated with increased vasoplegia, low-cardiac output syndrome, new-onset atrial fibrillation, acute kidney injury, mortality, mechanical ventilation duration, and ICU stay.
Conclusions:
- An elevated leucoglycemic index (LGI) ≥1484.75 independently predicts the need for significant vasopressor-inotropic support (VISindex ≥3) following adult cardiac surgery on CPB.
- LGI serves as a valuable predictive biomarker for post-cardiac surgery outcomes.
Background And Aims:
Cardiac surgery often necessitates considerable post-operative vasoactive-inotropic support. Given an encouraging literature on the prognostic potential of leucoglycemic index (LGI) [serum glucose (mg/dl) × total leucocytes count (cells/mm3)/1000], we aimed to evaluate whether intensive care unit (ICU)-admission LGI can predict post-operative vasopressor-inotropic requirements following cardiac surgery on cardio-pulmonary bypass (CPB).
Material And Methods:
The data of patients undergoing cardiac surgery at our tertiary care center between January 2015 and December 2020 was retrospectively reviewed. The vasopressor-inotropic requirement was estimated using the VIS (vasoactive-inotropic score) values over the first post-operative 72 hrs. Subsequently, VISi (indexed VIS) was computed as maxVIS[0-24hrs] + maxVIS[24-48hrs] +2 × maxVIS[48-72hrs]/10), and the study participants were divided into h-VISi (VISi ≥3) and l-VISi (VISi <3).
Results:
Out of 2138 patients, 479 (22.40%) patients categorized as h-VISi. On univariate analysis: LGI, age, European System for Cardiac Operative Risk Evaluation score (EuroSCORE II), left-ventricle ejection fraction, prior congestive heart failure (CHF), chronic renal failure, angiotensin-converting enzyme inhibitors, combined surgeries, CPB and aortic cross-clamp (ACC) duration, blood transfusion, and immediate post-operative glucose were significant h-VISi predictors. Subsequent to multi-variate analysis, the predictive performance of LGI (OR: 1.09; 95% CI: 1.03-1.14; P = 0.002) prior CHF (OR: 2.35; 95% CI: 1.44-3.82; P = 0.001), CPB time (OR: 1.08; 95% CI: 1.02-1.14; P = 0.019), ACC time (OR: 1.03; 95% CI: 1.02-1.04; P = 0.008), and EuroSCORE II (OR: 1.14; 95% CI: 1.06-1.21; P < 0.001) remained significant. With 1484.75 emerging as the h-VISi predictive cut-off, patients with LGI ≥ 1484.75 also had a higher incidence of vasoplegia, low-cardiac output syndrome, new-onset atrial fibrillation, acute kidney injury, and mortality. LGI additionally exhibited a significant positive correlation with duration of mechanical ventilation and ICU stay (R = 0.495 and 0.564, P value < 0.001).
Conclusion:
An elevated LGI of greater than 1484.75 independently predicted a VISindex ≥3 following adult cardiac surgery on CPB.
Related Concept Videos
01:26Heart Failure Drugs: Inotropic Agents
01:15Hypoglycemia and Glucagon
01:16Insulin: Dosing Regimen and Adverse Effects
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...