Risk factors and clinical outcome of postoperative hyperglycaemia after cardiac surgery with cardiopulmonary bypass

Yuping Xiang Tianhui Luo Ling Zeng ^*

• West China Hospital, Sichuan University, Chengdu, China

Background: High incidence of postoperative hyperglycaemia (PHG) in cardiac surgery with cardiopulmonary bypass (CPB), and increased morbidity and mortality. The purpose of this study was to evaluate the incidence of PHG after cardiac surgery with CPB, the independent risk factors, and its association with clinical outcomes.Methods: This was a retrospective, observational study, patients underwent cardiac surgery with CPB from January 2023 to March 2024 in West China Hospital of Sichuan University. 1008 consecutive postoperative cardiac surgery patients admitted to the cardiac surgery intensive care unit, were divided into non-PHG group and PHG group. Patients blood glucose levels were evaluated immediately after cardiac surgery and every 3-4 hours daily for 10 days, until discharge from the intensive care unit (ICU). For patients with PHG, intravenous insulin infusion was performed according to the institution's protocol, perioperative risk factors for hyperglycemia and clinical outcomes were assessed.Results: PHG defined as random blood glucose ≥10.0mmol/L (140 mg/dL) on the two occasion within 24 hours, occurred in 65.28% of cardiac surgery patients. Multivariable logistic regression analysis identified that age (odds ratio [OR] 1.054; 95% CI [1.040-1.069]; p < 0.001), famale (OR 1.380; 95% CI [1.023-1.864]; p =0.035), diabetes (OR 13.101; 95% CI [4.057-42.310]; p < 0.001), pulmonary infection (OR 1.918; 95% CI [1.129-3.258]; p = 0.016), aortic cross-clamp time (OR 1.007; 95% CI [1.003-1.010]; p < 0.001), intraoperative highest glucose (OR 1.515; 95% CI [1.370-1.675]; p < 0.001) emerged as independent risk factors for PHG. Moreover, PHG had higher rates of acute kidney injury, delirium, pulmonary infection; longer duration of mechanical ventilation , length of ICU stay, length of hospitalization, and higher rate of self-discharge or death compared with patients with non-PHG.Conclusions: PHG occurs frequently in patients after cardiac surgery. Age, famale, diabetes, pulmonary infection, aortic cross-clamp time, intraoperative highest glucose were independent risk factors for PHG. PHG is associated with worse clinical outcomes, including a higher rate of acute kidney injury, delirium and pulmonary infection, greater duration of mechanical ventilation, length of ICU stay, length of hospitalization and higher rate of automatic discharge or death.