Department of Pediatric Cardiac Anaesthesia and Critical Care, Sri Sathya Sai Sanjeevani Centre for Child Heart Care, Sector 37, Kharghar, Navi Mumbai, Maharashtra, India.
Critical Care Registrar, Apollo Hospital, Bannerghatta Road, Bengaluru, Karnataka, India.
Ann Card Anaesth. 2023 Apr-Jun;26(2):160-165. doi: 10.4103/aca.aca_46_22.
Recent studies have indicated that patients, both with and without diabetes with an increased HbA1c, have a higher rate of adverse outcomes following cardiac surgeries. Our study is focused on to evaluate the prognostic impact of admission value of HbA1c in non-diabetic patients for postoperative renal failure and infections.
Plasma HbA1c levels were collected from 200 consecutive nondiabetic patients who got admitted for elective off pump coronary artery bypass graft (CABG) procedure over a 2-year period under two groups, Group A whose HbA1c was < 6% at admission and Group B whose HbA1c was ≥6% and ≤6.4% at admission. After surgery, patients were followed up to see if they have got infection or renal failure as postoperative complication. Student's unpaired t test was used to test the significance of difference between the quantitative variables, Yate's and Fisher's chi square tests were used for qualitative variables.
We found early postoperative renal failure in 14 (3/96 in Group A and 11/104 in Group B) out of 200 patients (7%) and infection in 21 (8/96 in Group A and 13/104 in Group B) out of 200 patients (10.5%). After data analysis, it was noted that there is a positive correlation between HbA1c and postoperative renal failure (P = 0.0213) whereas no association was found between HbA1c and postoperative infections (P = 0.175) in patients undergoing off-pump CABG surgery.
In patients without diabetes, a plasma HbA1c ≥6% was a significant independent predictor for early postoperative renal failure.
最近的研究表明，无论是伴有还是不伴有 HbA1c 升高的糖尿病患者，在心脏手术后发生不良结局的风险都较高。我们的研究旨在评估非糖尿病患者入院时 HbA1c 值对术后肾衰竭和感染的预后影响。
在两年期间，从 200 例连续接受择期非体外循环冠状动脉旁路移植术（CABG）的非糖尿病患者中收集血浆 HbA1c 水平，将患者分为两组，A 组患者入院时 HbA1c<6%，B 组患者入院时 HbA1c≥6%且≤6.4%。手术后，随访患者是否发生感染或肾衰竭等术后并发症。使用 Student's unpaired t 检验测试定量变量之间的差异显著性，使用 Yate's 和 Fisher's 卡方检验测试定性变量。
我们发现 200 例患者中有 14 例（A 组 3/96，B 组 11/104）出现早期术后肾衰竭（7%），200 例患者中有 21 例（A 组 8/96，B 组 13/104）发生感染（10.5%）。数据分析后，发现 HbA1c 与术后肾衰竭呈正相关（P=0.0213），而 HbA1c 与非体外循环 CABG 术后感染之间无相关性（P=0.175）。
在非糖尿病患者中，血浆 HbA1c≥6%是早期术后肾衰竭的显著独立预测因素。
