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Prognostic Value of Leuko-glycemic Index as a Marker of Immediate Postoperative Events After Repair of Complete
Madan Mohan Maddali1, Muzna Al Zadjali2, Sowmiya Raju1
1Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman.
Insights
The leuko-glycemic index (LGI) can predict prolonged mechanical ventilation and acute kidney injury in infants with Down syndrome after heart surgery. Higher LGI values may indicate a need for closer monitoring and earlier interventions.
Area of Science:
- Pediatric Cardiology
- Biomarkers
- Critical Care Medicine
Background:
- The prognostic value of the leuko-glycemic index (LGI) in pediatric cardiac surgery is unknown.
- Infants with Down syndrome undergoing complete atrioventricular septal defect repair face specific postoperative challenges.
Purpose of the Study:
- To evaluate the predictive value of the LGI for composite postoperative outcomes.
- Specifically, to assess the LGI's ability to predict prolonged mechanical ventilation in infants with Down syndrome post-AVSD repair.
Main Methods:
- An ambidirectional cohort study was conducted at a single tertiary cardiac care center.
- 104 infants with Down syndrome and complete atrioventricular septal defects (AVSD) who underwent surgical repair were analyzed.
- Postoperative LGI was correlated with outcomes such as prolonged mechanical ventilation (≥24 hours) and acute kidney injury.
Main Results:
- A statistically significant correlation was found between postoperative LGI and prolonged mechanical ventilation (p=0.042).
- A postoperative LGI cutoff >1,640.16 predicted the need for prolonged mechanical ventilation (AUC=0.659).
- An LGI cutoff >2,657.88 differentiated patients who developed renal failure (AUC=0.723).
Conclusions:
- The LGI is a cost-effective and easily measurable prognostic tool for stratifying risk in the immediate postoperative period.
- Elevated LGI values in children with Down syndrome after AVSD repair may identify patients requiring enhanced monitoring and early therapeutic strategies.
- Utilizing LGI could help reduce mechanical ventilation duration and acute kidney injury incidence.
Objectives:
The prognostic value of the leuko-glycemic index (LGI) as a marker of postoperative outcomes in pediatric cardiac patients is not known. This study aimed to determine the predictive value of LGI in predicting composite outcomes, including prolonged mechanical ventilation, after the repair of a complete atrioventricular septal defect in infants with Down syndrome.
Design:
An ambidirectional cohort study.
Setting:
A single tertiary cardiac care center.
Participants:
Patients with Down syndrome and a complete atrioventricular septal defect.
Interventions:
All patients underwent primary intracardiac repair of a complete atrioventricular septal defect and received standard perioperative anesthesia and hemodynamic management.
Measurements And Main Results:
A total of 110 patients were enrolled, of whom 104 completed the study and were included in the final analysis. Prolonged mechanical ventilation was defined as a duration ≥24 hours. We found a statistically significant correlation between postoperative LGI and prolonged mechanical ventilation (p = 0.042). A postoperative LGI cutoff value >1,640.16 was associated with the need for prolonged mechanical ventilation. The area under the receiver operating characteristic curve (AUC) was 0.659 (95% CI, 0.548-0.771) with a sensitivity of 47.50% and a specificity of 81.25% (p = 0.005). A cutoff LGI value >2,657.88 was found to differentiate between patients who developed renal failure and those who did not, with an AUC of 0.723 (p = 0.019).
Conclusions:
The LGI, a cost-effective and easily measured index, could be a valuable prognostic tool to stratify children with Down syndrome in the immediate postoperative period after complete atrioventricular septal defect correction. High LGI values may identify patients who could benefit from greater monitoring and early therapeutic strategies to reduce the duration of mechanical ventilation and the incidence of acute kidney injury.
