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J Thorac Cardiovasc Surg 2005;130:1144
© 2005 The American Association for Thoracic Surgery
Cardiopulmonary Support and Physiology |
a Division of Cardiovascular Surgery, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
b Department of Anesthesia, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
c Department of Cardiovascular Surgery, University of Freiburg, Freiburg, Germany.
Received for publication May 17, 2004; revisions received May 18, 2005; accepted for publication May 25, 2005. * Address for reprints: Michael Borger, MD, Division of Cardiovascular Surgery, Toronto General Hospital, 200 Elizabeth St, 4N-451, Toronto, Ontario M5G 2C4, Canada (Email: michael.borger{at}uhn.on.ca).
BACKGROUND: Hyperglycemia is commonly present in the perioperative period in patients undergoing cardiac surgery, even during administration of insulin. A direct relationship between postoperative hyperglycemia and mortality has been established in diabetic patients undergoing cardiac surgery. However, this relationship might be confounded because patients with poor outcome receive more glucogenic drugs postoperatively. We assessed the influence of hyperglycemia (highest glucose level) during cardiopulmonary bypass on perioperative morbidity and mortality in diabetic and nondiabetic patients.
METHODS: We performed a multivariate logistic regression analysis on all diabetic (n = 1579) and nondiabetic (n = 4701) patients undergoing cardiac surgery at the Toronto General Hospital between 1999 and 2001. Boluses of insulin were given during cardiopulmonary bypass when the glucose level exceeded 15 mmol/L, when the serum potassium level exceeded 6.0 mmol/L, or both.
RESULTS: Overall mortality was 1.8% (n = 115). A high glucose level during cardiopulmonary bypass was an independent predictor of mortality in both diabetic (odds ratio, 1.20; confidence interval, 1.08-1.32) and nondiabetic (odds ratio, 1.12; confidence interval, 1.06-1.19; per millimole per liter increase in glucose) patients. A high glucose level during cardiopulmonary bypass was also an independent predictor of all major adverse events in both patient groups (odds ratio, 1.06; confidence interval, 1.03-1.09). A high glucose level was not closely related to cardiopulmonary bypass (r = 0.3) or aortic crossclamp times (r = 0.4).
CONCLUSIONS: A high peak serum glucose level during cardiopulmonary bypass is an independent risk factor for death and morbidity in diabetic patients and unexpectedly also in nondiabetic patients.
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