The effect of HbA1c on coronary artery bypass grafting mortality and morbidity in concomitant diabetes mellitus and coronary artery disease

Öz

Aim: In our study, we aimed to comparatively examine the effect of HbA1c levels and diabetes disease on patients undergoing isolated coronary bypass surgery. Material and Methods: 200 consecutive patients (152 male, 48 female, mean age 61.1) who underwent coronary artery bypass surgery (CABG) in our hospital were included in the study. The patients were divided into two groups. Group 1 consisted of patients with HbA1c ≥6.5 % (n=100) and group 2 consisted of patients with HbA1c <6.5% (n = 100). In group 1 all the patients were diabetic while in group 2, 30 patients were diabetic. There was no difference in preoperative risk factors between the groups. Results: Both groups had similar mortality rates. There was no difference in postoperative cerebrovascular accident, myocardial infarction, renal dysfunction, reoperation, atrial fibrillation, sepsis and superficial local infections. There was also no statistical difference in operative data, intensive care unit and hospital stay amongst the groups. In group 1, five patients had mediastinitis whilst there were no cases in group 2 and this was statistically significant (p = 0.030). Multivariate analysis revealed that an increase in postoperative blood glucose levels on the second postoperative day was predictive for mediastinitis (p = 0.036). ROC analysis showed that HbA1c >7.65% was the threshold value for occurrence of mediastinitis with a sensitivity of 80% and specificity of 65.6%. Conclusion: As a result, poor control of blood glucose levels following CABG is a risk factor for infection and HbA1c is a significant marker for identification of preoperative infection risk.

Anahtar Kelimeler

• HbA1c
• coronary artery bypass graft
• diabetes mellitus
• mediastinitis

Diyabetes mellitus ve koroner arter hastalığı birlikteliğinde hba1c’nin koroner baypas mortalitesi ve morbiditesine etkisi

Öz

Amaç: Çalışmamızda izole koroner bypass ameliyatı uygulanan hastalarda HbA1c düzeyi ve diyabet hastalığının etkisini karşılaştırmalı olarak incelemeyi amaçladık. Gereç ve Yöntemler: Çalışmaya hastanemizde koroner baypas cerrahisi geçiren ardışık 200 hasta (152 erkek, 48 kadın, yaş ortalaması 61,1) dahil edildi. Hastalar iki gruba ayrıldı. Grup 1, HbA1c seviyesi ≥ %6,5 olan hastalardan (n = 100) ve grup 2, HbA1c seviyesi < %6,5 olan hastalardan (n = 100) oluşuyordu. 1. gruptaki hastaların tamamı diyabetik iken 2. gruptaki hastaların 30'u diyabetikti. Gruplar arasında ameliyat öncesi risk faktörleri açısından fark bulunmamaktaydı. Bulgular: Her iki grupta da benzer ölüm oranları vardı. Postoperatif serebrovasküler olay, miyokard enfarktüsü, renal disfonksiyon, reeksplorasyon, atriyal fibrilasyon, sepsis ve yüzeyel lokal enfeksiyonlar açısından fark görülmedi. Gruplar arasında operasyon verileri, yoğun bakım ünitesinde kalış süresi ve hastanede kalış süresi açısından da istatistiksel olarak anlamlı fark saptanmadı. Grup 1'de 5 hastada mediastinit görülürken, grup 2'de hiç mediastinit görülmedi ve bu istatistiksel olarak anlamlıydı (p = 0,030). Multivaryant analizlerine göre, ameliyat sonrası ikinci günde kan şekeri düzeyindeki artışın mediastinit açısından öngörücü olduğu saptandı (p = 0,036). ROC analizi HbA1c > %7.65 değerinin, %80 duyarlılık ve %65 özgüllük ile mediastinit için eşik değer olduğunu gösterdi. Sonuçlar: Sonuç olarak, koroner baypas cerrahisi sonrası kan şekeri düzeylerinin yetersiz kontrolü enfeksiyon için bir risk faktörüdür ve HbA1c preoperatif enfeksiyon riskinin belirlenmesinde önemli bir belirteçtir.

Anahtar Kelimeler

• HbA1c
• koroner arter baypas greftleme
• diyabetes mellitus
• mediastinit

Kaynakça

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