Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery
Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery
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DOI：
10.1016/j.jtcvs.2005.05.049
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发表时间：
2005-10-01
影响因子：
6
通讯作者：
Borger, MA
中科院分区：
文献类型：
--
作者：
Doenst, T;Wijeysundera, D;Borger, MA
背景：高血糖通常出现在心脏手术患者的围手术期，甚至在使用胰岛素期间。在接受心脏手术的糖尿病患者中，术后高血糖与死亡率之间存在直接关系。然而，这种关系可能会被混淆，因为预后较差的患者术后接受更多的糖原药物。我们评估了体外循环期间高血糖（最高血糖水平）对糖尿病和非糖尿病患者围手术期发病率和死亡率的影响。方法：我们对1999年至2001年间在多伦多总医院接受心脏手术的所有糖尿病患者（n = 1579）和非糖尿病患者（n = 4701）进行了多因素logistic回归分析。在体外循环期间，当血糖水平超过15 mmol/L时，当血清钾水平超过6.0 mmol/L时，或两者同时给予胰岛素。结果：总死亡率为1.8% （n = 115）。体外循环期间的高葡萄糖水平是糖尿病（优势比1.20，可信区间1.08-1.32）和非糖尿病（优势比1.12，可信区间1.06-1.19，每毫升/升葡萄糖增加）患者死亡率的独立预测因子。在两组患者中，体外循环期间的高血糖水平也是所有主要不良事件的独立预测因子（优势比为1.06；置信区间为1.03-1.09）。高血糖水平与体外循环（r = 0.3）或主动脉夹持次数（r = 0.4）无关。结论：体外循环期间的高血糖峰值是糖尿病患者死亡和发病的独立危险因素，出乎意料的是非糖尿病患者也是如此。
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.