Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland; Department of Surgery, University of Oulu, Oulu, Finland.
Department of Surgery, Satakunta Central Hospital, Pori, Finland; Department of Plastic and General Surgery, Turku University Hospital and University of Turku, Turku, Finland.
Semin Thorac Cardiovasc Surg. 2019 Autumn;31(3):465-467. doi: 10.1053/j.semtcvs.2019.02.029. Epub 2019 Mar 6.
Increased glycated hemoglobin (HbA1c) has been shown to increase the risk of mortality, myocardial infarction, and stroke after cardiac surgery, whereas its impact on the development of sternal wound infection (SWI) is less clear. A systematic review and meta-analysis were performed to evaluate the impact of preoperative HbA1c levels on the occurrence of SWI after adult cardiac surgery. Fourteen studies including 17,609 patients fulfilled the inclusion criteria and were included in this analysis. Diagnostic test meta-analysis of studies evaluating baseline HbA1c cut-off values ranging from 6% to 7% DCCT units (42-53 mmol/mol IFCC units) showed that the diagnostic odds ratio for deep SWI was 3.02 (95% confidence interval [CI] 2.10-4.35), while the diagnostic odds ratio for any SWI was 2.81 (95% CI 2.02-3.93). Binary meta-analysis confirmed that baseline HbA1c cut-off values ranging from 6% to 7% increased the risk for deep SWI (pooled incidence 2.7% vs 0.8%, risk ratio [RR] 3.01, 95% CI 2.32-3.90, I 0%). Six studies included only diabetics and their pooled RR for deep SWI was 2.94 (1.59-5.45, I 0%). Nine studies evaluated an HbA1c cut-off value of 7% and their RR for deep SWI was 3.22 (95% CI 2.38-4.37, I 0%). The RR for any SWI was 2.92 (95% CI 2.42-3.53, I 0%). This pooled analysis showed that the risk of SWI is substantially increased when preoperative HbA1c levels are over 6-7%. Future studies should evaluate whether postponing surgery for optimization of the glycemic control can reduce the risk of SWI in patients with increased levels of HbA1c.
糖化血红蛋白（HbA1c）升高已被证明会增加心脏手术后的死亡率、心肌梗死和中风风险，但其对胸骨伤口感染（SWI）发展的影响尚不清楚。进行了系统评价和荟萃分析，以评估术前 HbA1c 水平对成人心脏手术后 SWI 发生的影响。符合纳入标准的 14 项研究共纳入 17609 例患者，纳入本分析。评估基线 HbA1c 截断值范围为 6%至 7%DCCT 单位（42-53mmol/mol IFCC 单位）的研究的诊断测试荟萃分析显示，深部 SWI 的诊断优势比为 3.02（95%置信区间[CI]2.10-4.35），而任何 SWI 的诊断优势比为 2.81（95%CI2.02-3.93）。二项式荟萃分析证实，基线 HbA1c 截断值范围为 6%至 7%增加了深部 SWI 的风险（汇总发生率 2.7%与 0.8%，风险比[RR]3.01，95%CI2.32-3.90，I 0%）。6 项研究仅纳入糖尿病患者，其深部 SWI 的汇总 RR 为 2.94（1.59-5.45，I 0%）。9 项研究评估了 HbA1c 截断值为 7%，其深部 SWI 的 RR 为 3.22（95%CI2.38-4.37，I 0%）。任何 SWI 的 RR 为 2.92（95%CI2.42-3.53，I 0%）。该汇总分析表明，当术前 HbA1c 水平超过 6-7%时，SWI 的风险显著增加。未来的研究应评估是否推迟手术以优化血糖控制是否可以降低 HbA1c 水平升高患者的 SWI 风险。
