Luthra Suvitesh, Viola Laura, Navaratnarajah Manoraj, Thirukumaran David, Velissaris Theodore
Wessex Cardiothoracic Centre, Division of Cardiac Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
Academic Unit of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK.
J Clin Med. 2024 Dec 24;14(1):23. doi: 10.3390/jcm14010023.
Perioperative dysglycaemia in cardiac surgery is associated with poor outcomes. Glycaemic variability rather than glucose levels is a predictor of the length of an ICU stay, a rise in creatinine and acute kidney injury after cardiac surgery. Glycated haemoglobin (HbA) values correspond closely to average blood glucose levels and cut-off values can be used to define a diabetic and pre-diabetic status. These have been correlated with perioperative events. In this narrative review, MEDLINE (via PubMed) and the Cochrane Library were used to search for the effects of different preoperative HbA levels on the postoperative outcomes after cardiac surgery. HbA values correspond closely with average blood glucose levels and cut-off values can be used to define a diabetic and pre-diabetic status; these have been correlated with perioperative events. This narrative review discusses the role of HbA in cardiac surgery. The scientific data show controversial results: some systematic reviews and randomised control trials demonstrated that a high level of HbA seems to be an indicator for postoperative complications in cardiac surgery; other studies dissented and reported that mortality and morbidity cannot be directly attributed to HbA levels. The scientific community seems to be in general agreement that high levels of HbA are prognostic markers of adverse outcomes post cardiac surgery, but it has also been proved that there could be multiple underlying factors contributing to them.
心脏手术围手术期血糖异常与不良预后相关。血糖变异性而非血糖水平是心脏手术后重症监护病房（ICU）住院时间、肌酐升高和急性肾损伤的预测指标。糖化血红蛋白（HbA）值与平均血糖水平密切相关，其临界值可用于定义糖尿病和糖尿病前期状态。这些指标与围手术期事件相关。在本叙述性综述中，通过MEDLINE（经PubMed）和Cochrane图书馆检索不同术前HbA水平对心脏手术后术后结局的影响。HbA值与平均血糖水平密切相关，其临界值可用于定义糖尿病和糖尿病前期状态；这些指标与围手术期事件相关。本叙述性综述讨论了HbA在心脏手术中的作用。科学数据显示出有争议的结果：一些系统评价和随机对照试验表明，高水平的HbA似乎是心脏手术术后并发症的一个指标；其他研究则持不同意见，报告称死亡率和发病率不能直接归因于HbA水平。科学界似乎普遍认为，高水平的HbA是心脏手术后不良结局的预后标志物，但也已证明可能有多种潜在因素导致这些不良结局。
