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

 Jong Wook Song  ;  Jae Kwang Shim  ;  Kyung Jong Yoo  ;  Se Young Oh  ;  Young Lan Kwak 
 Interactive Cardiovascular and Thoracic Surgery, Vol.17(3) : 473-478, 2013 
Journal Title
 Interactive Cardiovascular and Thoracic Surgery 
Issue Date
Acute Kidney Injury/blood ; Acute Kidney Injury/diagnosis ; Acute Kidney Injury/etiology* ; Aged ; Biomarkers/blood ; Blood Glucose/metabolism ; Chi-Square Distribution ; Coronary Artery Bypass, Off-Pump/adverse effects* ; Creatinine/blood ; Drug Administration Schedule ; Female ; Humans ; Hyperglycemia/blood ; Hyperglycemia/diagnosis ; Hyperglycemia/drug therapy ; Hyperglycemia/etiology* ; Hypoglycemic Agents/administration & dosage ; Insulin Lispro/administration & dosage ; Intraoperative Period ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Postoperative Period ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome
Acute kidney injury ; Coronary artery bypass ; Hyperglycaemia ; Off pump
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.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Song, Jong Wook(송종욱) ORCID logo https://orcid.org/0000-0001-7518-2070
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Oh, Se Young(오세영)
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
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