Abstract
BackgroundInsulin resistance and adiponectin are markers of cardio-metabolic disease and associated with adverse cardiovascular outcomes. The present study examined whether preoperative insulin resistance or adiponectin were associated with short- and long-term adverse outcomes in non-diabetic patients undergoing elective cardiac surgery.MethodsIn a prospective study, we assessed insulin resistance and adiponectin levels from preoperative fasting blood samples in 836 patients undergoing cardiac surgery. Population-based medical registries were used for postoperative follow-up. Outcomes included all-cause death, myocardial infarction or percutaneous coronary intervention, stroke, re-exploration, renal failure, and infections. The ability of insulin resistance and adiponectin to predict clinical adverse outcomes was examined using receiver operating characteristics.ResultsNeither insulin resistance nor adiponectin were statistically significantly associated with 30-day mortality, but adiponectin was associated with an increased 31-365-day mortality (adjusted odds ratio 2.9 [95% confidence interval 1.3-6.4]) comparing the upper quartile with the three lower quartiles. Insulin resistance was a poor predictor of adverse outcomes. In contrast, the predictive accuracy of adiponectin (area under curve 0.75 [95% confidence interval 0.65-0.85]) was similar to that of the EuroSCORE (area under curve 0.75 [95% confidence interval 0.67-0.83]) and a model including adiponectin and the EuroSCORE had an area under curve of 0.78 [95% confidence interval 0.68-0.88] concerning 31-365-day mortality.ConclusionsElevated adiponectin levels, but not insulin resistance, were associated with increased mortality and appear to be a strong predictor of long-term mortality. Additional studies are warranted to further clarify the possible clinical role of adiponectin assessment in cardiac surgery.Trial RegistrationThe Danish Data Protection Agency; reference no. 2007-41-1514.
Highlights
Insulin resistance and adiponectin are markers of cardio-metabolic disease and associated with adverse cardiovascular outcomes
homeostasis model assessment (HOMA) was inversely correlated with adiponectin, the EuroSCORE, microalbuminuria, type of procedure performed and cross-clamp time, but showed no correlation with age (Table 1)
Patients with high HOMA levels had more solitary coronary bypass and less valve procedures performed, whereas increasing adiponectin levels were correlated with more valve procedures and less bypass procedures being performed (Table 1)
Summary
Insulin resistance and adiponectin are markers of cardio-metabolic disease and associated with adverse cardiovascular outcomes. The present study examined whether preoperative insulin resistance or adiponectin were associated with short- and long-term adverse outcomes in non-diabetic patients undergoing elective cardiac surgery. Insulin resistance and circulating levels of adiponectin are associated with an increased risk of cardiovascular disease, the metabolic syndrome and a subclinical inflammatory response in the vascular endothelium [1,2]. Its prevalence in the apparently healthy population is rising [3] It declines during critical illness and as a response to surgery [1]. In a recently published study in patients undergoing cardiac surgery, intraoperative insulin resistance was associated with an increased risk of short-term adverse outcomes [4]. Hyperglycemia during cardiopulmonary bypass and preoperative metabolic syndrome, in which insulin resistance plays a key role, were powerful risk factors of mortality and morbidity in patients undergoing cardiac surgery [5,6]
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