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Impact of intraoperative hyperglycaemia on renal dysfunction after off-pump coronary artery bypass

Title
Impact of intraoperative hyperglycaemia on renal dysfunction after off-pump coronary artery bypass
Authors
Jong Wook Song;Jae Kwang Shim;Young Lan Kwak;Se Young Oh;Kyung Jong Yoo
Issue Date
2013
Journal Title
Interactive Cardiovascular and Thoracic Surgery
ISSN
1569-9293
Citation
Interactive Cardiovascular and Thoracic Surgery, Vol.17(3) : 473~478, 2013
Abstract
OBJECTIVES: Acute kidney injury (AKI) is one of the most frequently occurring complications after off-pump coronary artery bypass graft (OPCAB). Hyperglycaemia is a major, potentially modifiable risk factor of adverse outcome after cardiac surgery known to aggravate organ damage. The aim of this study was to address the association between intraoperative glucose concentration and postoperative AKI in patients who underwent OPCAB. METHODS: The medical records of 880 consecutive patients were retrospectively reviewed. Patients were divided into three groups according to the time-weighted average of intraoperative glucose concentrations (<110, 110-150 and >150 mg/dl), and the incidence of AKI (increase of serum creatinine to >2.0 mg/dl and 2 × most recent preoperative value or a new requirement for dialysis) was compared. Multivariate logistic regression analysis was performed to identify independent risk factors for postoperative AKI. RESULTS: The incidence of AKI was higher in patients with a glucose level >150 mg/dl than in patients with a glucose level = 110-150 mg/dl [8% (20 of 251) vs 3% (14 of 453), P = 0.004]. On multivariate analysis, glucose >150 mg/dl (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.12-6.86, P = 0.027), coefficient of variation of glucose (OR, 1.04; 95% CI, 1.01-1.07, P = 0.027) and preoperative serum creatinine >1.4 mg/dl (OR, 8.81; 95% CI, 3.90-19.9, P < 0.001) were identified as independent risk factors for postoperative AKI. CONCLUSIONS: Intraoperative glucose concentration >150 mg/dl and increased variability of glucose were independently associated with AKI after OPCAB. Tight intraoperative glycaemic control (<110 mg/dl) does not seem to provide additional benefit in terms of AKI.
URI
http://icvts.oxfordjournals.org/content/17/3/473.long

http://ir.ymlib.yonsei.ac.kr/handle/22282913/87511
DOI
10.1093/icvts/ivt209
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Anesthesiology and Pain Medicine
1. 연구논문 > 1. College of Medicine > Dept. of Thoracic & Cardiovascular Surgery
Yonsei Authors
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