Karam Nam1, Yunseok Jeon1, Won Ho Kim1, Dhong Eun Jung1, Seok Min Kwon1,2, Pyoyoon Kang1,2, Youn Joung Cho1, Tae Kyong Kim3,4. 1. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea. 2. Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea. 3. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea. ktkktk@gmail.com. 4. Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. ktkktk@gmail.com.
Abstract
PURPOSE: Altered perioperative glycemic control may contribute to the development of renal dysfunction in cardiac surgery patients. Nevertheless, whether it is intraoperative hyperglycemia or increased glucose variability that affects postoperative outcomes is not yet clear. The aim of this study was to assess the association of intraoperative glucose concentration and variability with acute kidney injury (AKI) after cardiac surgery. METHODS: We retrospectively reviewed the electronic medical records of 3,598 patients who underwent cardiac surgery between November 1, 2006 to December 31, 2016. The time-weighted average glucose (TWAG) and coefficient of variation of glucose measurements were both used as measures of intraoperative glucose control with multivariable logistic regression to evaluate their relationship to postoperative AKI. RESULTS: The intraoperative glucose coefficient of variation was an independent risk factor for AKI after cardiac surgery (highest quartile odds ratio, 1.38; 95% confidence interval, 1.09 to 1.75; P = 0.01). Nevertheless, the intraoperative TWAG did not remain in the final multivariable model of postoperative AKI. CONCLUSION: Intraoperative glucose variability, but not the average glucose concentration itself, may be a risk factor for AKI after cardiac surgery.
PURPOSE: Altered perioperative glycemic control may contribute to the development of renal dysfunction in cardiac surgery patients. Nevertheless, whether it is intraoperative hyperglycemia or increased glucose variability that affects postoperative outcomes is not yet clear. The aim of this study was to assess the association of intraoperative glucose concentration and variability with acute kidney injury (AKI) after cardiac surgery. METHODS: We retrospectively reviewed the electronic medical records of 3,598 patients who underwent cardiac surgery between November 1, 2006 to December 31, 2016. The time-weighted average glucose (TWAG) and coefficient of variation of glucose measurements were both used as measures of intraoperative glucose control with multivariable logistic regression to evaluate their relationship to postoperative AKI. RESULTS: The intraoperative glucose coefficient of variation was an independent risk factor for AKI after cardiac surgery (highest quartile odds ratio, 1.38; 95% confidence interval, 1.09 to 1.75; P = 0.01). Nevertheless, the intraoperative TWAG did not remain in the final multivariable model of postoperative AKI. CONCLUSION: Intraoperative glucose variability, but not the average glucose concentration itself, may be a risk factor for AKI after cardiac surgery.
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