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Noniatrogenic hypoglycemia: A universal marker for poor outcomes
Hannah Rando1, Matthew Acton1, Ifeanyi Chinedozi1
1Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
JTCVS Open
|January 9, 2025
Summary
Postoperative hypoglycemia after cardiac surgery is linked to adverse outcomes. Iatrogenic hypoglycemia, often from insulin errors, has significantly lower mortality than noniatrogenic causes.
Area of Science:
- Cardiology
- Endocrinology
- Critical Care Medicine
Background:
- Previous studies linked postoperative hypoglycemia to adverse outcomes in cardiac surgery.
- The cause of hypoglycemia has not been previously accounted for in these studies.
Purpose of the Study:
- To investigate the association between the cause of postoperative hypoglycemia and adverse outcomes after cardiac surgery.
- To differentiate outcomes between iatrogenic and noniatrogenic hypoglycemia.
Main Methods:
- Retrospective review of 5373 cardiac surgery patients (2016-2021).
- Hypoglycemia defined as blood glucose < 70 mg/dL postoperatively.
- Subcategorization into iatrogenic (e.g., insulin errors) and noniatrogenic (e.g., liver failure, sepsis) causes.
Main Results:
- 5% of patients experienced hypoglycemia; 63% were iatrogenic, 37% noniatrogenic.
- Both hypoglycemia types were associated with increased renal failure, prolonged ventilation, and ICU stay.
- Noniatrogenic hypoglycemia significantly increased mortality (OR 68.6), while iatrogenic hypoglycemia did not (OR 1.45).
Conclusions:
- The cause of hypoglycemia is critical when assessing outcomes after cardiac surgery.
- Iatrogenic hypoglycemia, particularly from insulin management errors, has a substantially attenuated association with morbidity and mortality compared to noniatrogenic causes.
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