Division of Cardiac Surgery, University of Parma, Parma, Italy.
Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.
Int J Surg. 2018 May;53:354-359. doi: 10.1016/j.ijsu.2018.04.021. Epub 2018 Apr 14.
Patients with increased glycated hemoglobin (HbA1c) seem to be at increased risk of sternal wound infection (SWI) after coronary artery bypass grafting (CABG). However, it is unclear whether increased baseline HbA1c levels may affect other postoperative outcomes.
Data on preoperative levels of HbA1c were collected from 2606 patients undergoing elective isolated CABG from 2015 to 2016 and included in the prospective, multicenter E-CABG registry.
The prevalence of HbA1c ≥ 53 mmol/mol (7.0%) among non-diabetics was 5.3%, among non-insulin dependent diabetics was 53.5% and among insulin dependent diabetics was 67.1% (p < 0.001). The prevalence of HbA1c > 75 mmol/mol (9.0%) among non-diabetics was 0.5%, among non-insulin dependent diabetics was 5.8% and among insulin dependent diabetics was 10.6% (p < 0.001). Baseline levels of HbA1c ≥ 53 mmol/mol (7.0%) was a significant predictor of any SWI (10.7% vs. 3.3%, adjusted p-value: <0.001), deep SWI/mediastinitis (3.8% vs. 1.3%, adjusted p-value: 0.001) and acute kidney injury (27.4% vs. 19.8%, adjusted p-value: 0.042). These findings were confirmed in multilevel mixed effect logistic regression adjusted for participating centers. Among patients with diabetes, HbA1c ≥ 53 mmol/mol (7.0%) was predictive of SWI (11.1% vs. 4.8%, p = 0.001).
HbA1c is increased in a significant proportion of patients undergoing elective CABG and these patients are at higher risk of SWI. Less clear is the impact of increased HbA1c on other postoperative outcomes. These results do not support screening of HbA1c in patients without history of diabetes. Preoperative screening of HbA1c is valuable only to identify diabetics at risk of SWI.
糖化血红蛋白（HbA1c）升高的患者在接受冠状动脉旁路移植术（CABG）后似乎有更高的胸骨伤口感染（SWI）风险。然而，HbA1c 基线水平升高是否会影响其他术后结果尚不清楚。
从 2015 年至 2016 年接受择期单纯 CABG 的 2606 例患者中收集了术前 HbA1c 水平的数据，并将其纳入前瞻性、多中心 E-CABG 登记处。
非糖尿病患者中 HbA1c≥53mmol/mol（7.0%）的患病率为 5.3%，非胰岛素依赖型糖尿病患者为 53.5%，胰岛素依赖型糖尿病患者为 67.1%（p<0.001）。非糖尿病患者中 HbA1c>75mmol/mol（9.0%）的患病率为 0.5%，非胰岛素依赖型糖尿病患者为 5.8%，胰岛素依赖型糖尿病患者为 10.6%（p<0.001）。HbA1c≥53mmol/mol（7.0%）基线水平是任何 SWI（10.7% vs. 3.3%，调整后的 p 值：<0.001）、深部 SWI/纵隔炎（3.8% vs. 1.3%，调整后的 p 值：0.001）和急性肾损伤（27.4% vs. 19.8%，调整后的 p 值：0.042）的显著预测因子。这些发现经多水平混合效应逻辑回归校正后在参与中心得到证实。在糖尿病患者中，HbA1c≥53mmol/mol（7.0%）可预测 SWI（11.1% vs. 4.8%，p=0.001）。
HbA1c 在接受择期 CABG 的患者中有相当大的比例升高，这些患者发生 SWI 的风险更高。HbA1c 升高对其他术后结果的影响尚不清楚。这些结果不支持对无糖尿病史的患者进行 HbA1c 筛查。术前 HbA1c 筛查仅对识别有 SWI 风险的糖尿病患者有价值。
