Association of Preoperative Hemoglobin A1c with In-hospital Mortality Following Valvular Heart Surgery.

Mohammadreza Shoghli,Seyedeh Hamideh Mortazavi,Rajesh Jain,Leyla Pourgholi,Mohamamdali Boroumand,Arash Jalali,Seyed Hossein Ahmadi Tafti,Shayan Ziaee,Akbar Shafiee,Aras Rafiee

doi:10.21470/1678-9741-2019-0320

Mohammadreza Shoghli, Seyedeh Hamideh Mortazavi + Show 8 more

Open Access

https://doi.org/10.21470/1678-9741-2019-0320

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Abstract

ObjectiveTo determine the association between the preoperative level of hemoglobin A1c (HbA1c) and in-hospital mortality in patients who underwent valvular heart surgery in our center in a retrospective cohort.MethodsIn this retrospective consecutive cohort study, patients with type 2 diabetes mellitus who were referred to our center for elective valvular surgery were enrolled and followed up. The endpoint of this study was in-hospital mortality. Based on the level of HbA1c, patients were dichotomized around a level of 7% into two groups: exposed patients with HbA1c ≥ 7% and unexposed patients with HbA1c < 7%. Then, the study variables were compared between the two groups.ResultsTwo hundred twenty-four diabetic patients who were candidates for valvular surgery were enrolled; 106 patients (47.3%) had HbA1c < 7%, and 118 patients (52.6%) had HbA1c ≥ 7%. The duration of diabetes was higher in patients with HbA1c ≥ 7% (P=0.007). Thirteen (5.8%) patients died during hospital admission, of which nine patients were in the high HbA1c group. There was no significant difference between the groups regarding in-hospital mortality (P=0.899). Both the unadjusted and adjusted logistic regression models showed that HbA1c was not a predictor for in-hospital mortality (P=0.227 and P=0.388, respectively)ConclusionThis study showed no association between preoperative HbA1c levels and in-hospital mortality in candidates for valvular heart surgery.

Highlights

The global incidence and prevalence of diabetes mellitus are dramatically increasing in recent years, and in 2011, almost 25% of the Iranian population had impaired fasting glucose or diabetes mellitus[1,2]
There was no significant difference between the groups regarding inhospital mortality (P=0.899)
Both the unadjusted and adjusted logistic regression models showed that Hemoglobin A1c (HbA1c) was not a predictor for in-hospital mortality (P=0.227 and P=0.388, respectively)

Summary

Introduction

The global incidence and prevalence of diabetes mellitus are dramatically increasing in recent years, and in 2011, almost 25% of the Iranian population had impaired fasting glucose or diabetes mellitus[1,2]. Control of blood glucose in patients who undergo any surgical operation is crucial as diabetes mellitus has been linked to the development of many adverse outcomes following open-heart surgeries, such as sepsis, wound infection, cerebrovascular accidents, postoperative atrial fibrillation, and mortality[3,4,5,6]. A valid and reliable marker for the evaluation of diabetes control can help much to reduce these complications. Hemoglobin A1c (HbA1c) has been introduced as a useful marker that can show the situation of glucose control in the past 8-12 weeks before the evaluation[7].

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