Elevated Hemoglobin A1c Is Associated With Lower Socioeconomic Position and Increased Postoperative Infections and Longer Hospital Stay After Cardiac Surgical Procedures
Elevated Hemoglobin A1c Is Associated With Lower Socioeconomic Position and Increased Postoperative Infections and Longer Hospital Stay After Cardiac Surgical Procedures
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DOI：
10.1016/j.athoracsur.2016.05.092
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发表时间：
2017-01-01
影响因子：
4.6
通讯作者：
Flynn, Brigid C.
中科院分区：
文献类型：
--
作者：
Finger, Brooke;Brase, Jason;Flynn, Brigid C.
背景资料。血红蛋白A1c(HbA1c)水平升高的患者心脏外科手术后短期和长期不良结果的风险增加。HbA1c水平升高是否与较低的社会经济地位(SEP)相关尚不清楚。回顾了2014年在堪萨斯州堪萨斯城堪萨斯大学医学中心接受心脏手术的所有成年患者(n=567)。在这些患者中，531人在手术前测量了HbA1c水平。糖化血红蛋白(HbA1c)为7%或以下或大于7%。这项研究的两个目的是评估HbA1c和SEP的可能相关性，以及评估HbA1c水平与心脏外科手术后不良预后的可能相关性。手术后的主要结果是感染和重症监护病房的住院时间。糖化血红蛋白水平高于7%与较低的体感诱发电位(p=0.005)和术后感染风险的增加(p<；0.001)相关。HbA1c>7%的患者住院总时间更长(p=0.009)。糖化血红蛋白水平升高与SEP降低有关。这种关联不仅可能阻碍纠正HbA1c水平的能力，还可能增加HbA1c水平升高的风险。此外，HbA1c高于7%的心脏手术患者术后感染的风险增加。(C)2017年，由胸外科医生学会主办
Background. Patients with elevated hemoglobin A1c (HbA1c) levels have an increased risk of adverse shortand long-term outcomes after cardiac surgical procedures. Whether elevated HbA1c levels are associated with lower socioeconomic position (SEP) has been unknown.Methods. All adult patients undergoing cardiac surgical procedures at Kansas University Medical Center in Kansas City, Kansas in 2014 (n = 567) were reviewed. Of those patients, 531 had a preoperative HbA1c level measured. HbA1c was delineated as 7% or lower or greater than 7%. The two aims of this study were to evaluate a possible association of HbA1c and SEP and to evaluate for a possible association of HbA1c levels and poor outcomes after cardiac surgical procedures. The primary postsurgical outcomes were infections and intensive care unit length of stay.Results. HbA1c levels greater than 7% were associated with lower SEP (p = 0.005) and with increased risk of infection postoperatively (p < 0.001). Total hospital length of stay tended to be longer for patients with HbA1c greater than 7% (p = 0.009).Conclusions. Elevated HbA1c levels are associated with lower SEP. This association not only may hinder the ability to correct HbA1c levels, but also may impart a risk for elevated HbA1c levels. Additionally, patients who present for cardiac operations with HbA1c greater than 7% have an increased risk of postoperative infections. (C) 2017 by The Society of Thoracic Surgeons