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Glycated Haemoglobin (HbA1C) in Cardiac Surgery: A Narrative Review
Suvitesh Luthra1,2, Laura Viola1, Manoraj Navaratnarajah1
1Wessex Cardiothoracic Centre, Division of Cardiac Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
Insights
High preoperative glycated haemoglobin (HbA1C) levels may indicate adverse outcomes after cardiac surgery. However, the scientific community acknowledges that other factors likely contribute to these postoperative complications.
Area of Science:
- Cardiology
- Endocrinology
- Anesthesiology
Background:
- Perioperative dysglycaemia in cardiac surgery is linked to adverse outcomes.
- Glycaemic variability, not just glucose levels, predicts ICU stay, creatinine rise, and acute kidney injury.
- Glycated haemoglobin (HbA1C) reflects average blood glucose and defines diabetic/pre-diabetic status, correlating with perioperative events.
Purpose of the Study:
- To review the impact of preoperative HbA1C levels on postoperative outcomes in cardiac surgery.
- To discuss the role of HbA1C in managing patients undergoing cardiac procedures.
- To synthesize current scientific understanding of HbA1C as a prognostic marker in this context.
Main Methods:
- A narrative review of studies identified through MEDLINE (PubMed) and the Cochrane Library.
- Focused search on the correlation between preoperative HbA1C levels and postoperative results.
- Analysis of existing data on HbA1C's predictive value in cardiac surgery patients.
Main Results:
- Conflicting scientific data exists regarding HbA1C's predictive power.
- Some studies indicate high HbA1C as an indicator of postoperative complications.
- Other research suggests mortality and morbidity are not solely attributable to HbA1C levels.
Conclusions:
- General agreement exists that high HbA1C levels are prognostic markers for adverse outcomes post-cardiac surgery.
- Evidence suggests multiple underlying factors contribute to these adverse outcomes.
- Further research may be needed to elucidate the complex interplay of factors.
Abstract:
Background: Perioperative dysglycaemia in cardiac surgery is associated with poor outcomes. Glycaemic variability rather than glucose levels is a predictor of the length of an ICU stay, a rise in creatinine and acute kidney injury after cardiac surgery. Glycated haemoglobin (HbA1C) values correspond closely to average blood glucose levels and cut-off values can be used to define a diabetic and pre-diabetic status. These have been correlated with perioperative events. Methods: In this narrative review, MEDLINE (via PubMed) and the Cochrane Library were used to search for the effects of different preoperative HbA1C levels on the postoperative outcomes after cardiac surgery. HbA1C values correspond closely with average blood glucose levels and cut-off values can be used to define a diabetic and pre-diabetic status; these have been correlated with perioperative events. This narrative review discusses the role of HbA1C in cardiac surgery. Discussion: The scientific data show controversial results: some systematic reviews and randomised control trials demonstrated that a high level of HbA1C seems to be an indicator for postoperative complications in cardiac surgery; other studies dissented and reported that mortality and morbidity cannot be directly attributed to HbA1c levels. Conclusions: The scientific community seems to be in general agreement that high levels of HbA1C are prognostic markers of adverse outcomes post cardiac surgery, but it has also been proved that there could be multiple underlying factors contributing to them.
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