González FB, Buchaca FEF, Rodríguez AL, Mora DI

Language: Spanish
References: 11
Page: 1-9
PDF size: 291.26 Kb.

ABSTRACT

Introduction: Fasting hyperglycemia is a prognostic factor in surgery. Finding the highest risk threshold in cardiovascular surgery is a necessity in current medical practice.
Objective: To estimate the ideal fasting glycemic threshold for a better prognosis in the clinical evolution of patients undergoing cardiac surgery.
Methods: A prospective descriptive study was carried out in patients undergoing cardiac surgery, at “Hermanos Ameijeiras” Hospital from January to June 2017. The sample consisted of 191 patients; fasting blood glucose was determined in all patients. The Chi-square (X2) test of independence was used to evaluate the association between variables. A logistic regression analysis was performed to identify the independent effect of the variables studied. In addition, a Receiver Operating Characteristic Curve was constructed in which 1-specificity and sensitivity were plotted for each cut-off point defined for the glycemic values.
Results: The 40-69 years age of the patients predominated, the male sex represented 60.7% of the sample, 55.5% had normal blood glucose levels and only 1.6% showed blood glucose levels higher than 15 mmol/L. Moreover, 33.5% had some type of complication; the patients with complications had blood glucose levels above 9.9 mmol/L in 84.4%. In the multivariate analysis, there was only statistical significance for the appearance of complications for glycaemia higher than 10 mmol/L.
Conclusions: Fasting hyperglycemia was associated with higher risk of complications.

REFERENCES

1. Lansang MC, Umpierrez GE. Inpatient hyperglycemia management: A practical review for primary medical and surgical teams. Cleve Clin J Med. 2016;83(51):S34-43. Disponible en: https://doi.org/10.3949/ccjm.83.s1.06

2. Luna-Ortiz P, Carbo R, Rojas E, de Micheli A, Pastelin G, Martinez M. El control estricto de la glucosa y la cardioprotección. Revista Mexicana de Anestesiología. 2008[acceso: 22/03/2020];31(4):298-310. Disponible en: Disponible en: https://ww.research.gate.net

3. Gómez-Romero P, Cabrera Jardines R, Díaz Green E, Rodriguez-Weber FL. Control glucémico perioperatorio: su importancia y relación con complicaciones postquirúrgicas. Med Int Mex. 2016[acceso: 18/02/2020];32(6):661-67. Disponible en: Disponible en: https://www.medicinainterna.org.mx

4. Marik PE, Bellomo R. Stress hyperglycemia an essential survival response. Crit Care. 2013[acceso: 22/03/2020];17:305. Disponible en: Disponible en: https://pubmed.ncbi.nim.nih.gov:10.1186/cc12514

5. Bláha J, Mraz M, Kopecky P, Strilesky M. Perioperative tight glucose control reduces postoperative adverse event in non-diabetic cardiac surgery patients. J Clin Endocrinol Metab. 2015[acceso: 22/03/2020];100:3081-9. Disponible en: Disponible en: https://pubmed.ncbi.nim.nih.gov:10.1210/jc.2015-1959

6. Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR, et al. Society of Thoracic Surgeons Blood Glucose Guideline Task Force: The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. Ann Thorac Surg. 2009[acceso: 22/03/2020];87:663-9. Disponible en: Disponible en: https://pubmed.ncbi.nim.nih.gov:10.1016/j.athoracsur.2008.11.011

7. Desai SP, Henry LL, Holmes SD, Hunt SL, Martin CT, Hebsur S, et al. Strict versus liberal target range for perioperative glucose in patients undergoing coronary artery bypass grafting: a prospective randomized controlled trial. J Thorac Cardiovasc Surg. 2012[acceso: 22/03/2020];143(2):318-25. Disponible en Disponible en https://pubmed.ncbi.nim.nih.gov.10.1016/j.jtcvs.2011.10.070

8. Shah B, Burdowski J, Lobach I, Gianos E, Sedlis SP. A risk score for prediction of hyperglycemia at coronary angiography. JACC Cardiovasc Interv. 2014[acceso: 14/04/2020];7(10):1199-201. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4405887/

9. Greco G, Ferket BS, D’Alessandro DA, Shi W, Horvath KA, Rosen A, et al. Diabetes and the association of posoperative hyperglycemia with clinical and economic outcomes in cardiac surgery. Diabetes care. 2016[acceso: 14/04/2020];39(3):408-17. Disponible en: Disponible en: https://care.diabetesjournals.org/content/diacare/39/3/408.full.pdf

10. Galindo RJ, Davis GM, Fayfman M, Reyes-Umpierrez D, Alfa D, Peng L, et al. Comparison of efficacy and safety of glargine and determin insulin in the management of inpatient hyperglycemia and diabetes. Endocr Pract. 2017;23(9):1059-66. Disponible en: https://doi.org/10.4158/EP171804.OR

11. Peñafiel KJ, Preciado GS, Solórzano JA, Salazar JL. Respuesta metabólica al estrés en pacientes adultos. Revista Científica de la Investigación y el Conocimiento. 2019[acceso: 14/04/2020];3(1):1050-74. Disponible en: Disponible en: http://www.recimundo.com/index.php/es/article/view/405