Preoperative Glycocalyx Status and Postoperative Organ Failure After Cardiac Surgery in the GLYPOCS Observational...

Cardiac surgery with cardiopulmonary bypass induces systemic inflammation and glycocalyx degradation, both associated with postoperative complications. Cardiac surgery patients, who have multiple conditions affecting systemic microvascularization, may present with pre-existing alterations before surgery, and it is not known whether this increases the risk of postoperative complications. This study aimed to assess whether preoperative glycocalyx and microcirculatory impairments are associated with an increased risk of postoperative complications in cardiac surgery.

This prospective, single-center study included 119 patients undergoing cardiac surgery between December 2020 and August 2023.

Sublingual glycocalyx and microcirculation were measured preoperatively using the GlycoCheck device. The primary endpoint was organ failure within 48 hours postoperatively, with secondary endpoints including complications within 28 days.

Early complications occurred in 53.8% of patients, with acute kidney injury (Kidney Disease: Improving Global Outcomes score ≥ 2) being the most frequent. Glycocalyx thickness (peripheral boundary region [PBR]) did not significantly differ between patients with and without complications. However, preoperative microvascular flow was significantly decreased in patients presenting with early complications (adjusted odds ratio, 0.9957 per µm/s, p = 0.01). Decreased microvascular flow and capillary density were significantly associated with acute kidney injury and respiratory failure.

Preoperative glycocalyx thickness, evaluated using PBR, was not associated with postoperative complications. Reduced preoperative microvascular flow was independently associated with early postoperative complications after cardiac surgery. These findings suggest that preoperative microcirculatory assessment may warrant further investigations in future studies.