Zhongguo quanke yixue (Jun 2022)
Association of Preoperative Glycosylated Hemoglobin with the Prognosis of Adult Patients Undergoing Cardiac Surgery: a Meta-analysis
Abstract
Background The association between preoperative glycosylated hemoglobin (HbA1c) and prognosis of adult patients undergoing cardiac surgery has attracted attentions of scholars. However, due to various reference values of preoperative HbA1c, the prognostic threshold of preoperative HbA1c used for these patients is different. Objective To perform a Meta-analysis to examine the association between preoperative HbA1c and prognosis in adult patients undergoing cardiac surgery. Methods Databases of CNKI, Wanfang Data, Medline, EMBase, The Cochrane Library were searched to collect case-control studies, prospective or retrospective cohort studies on the association between preoperative HbA1c and prognosis in adults undergoing cardiac surgery from January 1st, 2000 to September 10th, 2021. Studies screening, data extraction, and risk of bias assessment were performed by two researchers independently. RevMan 5.4.1 was used to perform the Meta-analysis. Results A total of 35 cohort studies involving 35 826 adult cardiac surgery patients were included. The prognosis of these cases was analyzed by the control level of preoperative HbA1c. Meta-analysis revealed that adults with preoperative HbA1c < 5.5% had lower early postoperative mortality than those with preoperative HbA1c ≥5.5%〔RR=0.39, 95%CI (0.18, 0.84) , P=0.02〕. A lower rate of postoperative sternal wound infection was found in those with preoperative HbA1c< 6.0% rather than those with preoperative HbA1c≥6.0%〔RR=0.47, 95%CI (0.24, 0.91) , P=0.02〕, in those with preoperative HbA1c<6.5% rather than those with preoperative HbA1c≥6.5%〔RR=0.48, 95%CI (0.34, 0.69) , P<0.000 1〕, in those with preoperative HbA1c<7.0% rather than those with preoperative HbA1c≥7.0%〔RR=0.37, 95%CI (0.26, 0.52) , P<0.000 01〕, in those with preoperative HbA1c< 7.5% rather than those with preoperative HbA1c≥7.5%〔RR=0.22, 95%CI (0.13, 0.35) , P<0.000 01〕, or in those with preoperative HbA1c<8.0% rather than those with preoperative HbA1c ≥8.0%〔RR=0.23, 95%CI (0.14, 0.38) , P<0.000 01〕. A lower incidence of postoperative cerebrovascular events was observed in those with preoperative HbA1c< 6.5% rather than those with preoperative HbA1c≥6.5%〔RR=0.70, 95%CI (0.52, 0.94) , P=0.02〕, in those with preoperative HbA1c<7.0% rather than those with preoperative HbA1c≥7.0%〔RR=0.52, 95%CI (0.39, 0.69) , P<0.000 01〕, in those with preoperative HbA1c<7.5% rather than those with preoperative HbA1c≥7.5%〔RR=0.50, 95%CI (0.32, 0.80) , P=0.003〕, or in those with preoperative HbA1c<8.0% tather than those with preoperative HbA1c ≥8.0% 〔RR=0.47, 95%CI (0.29, 0.75) , P=0.002〕. A lower incidence of postoperative acute kidney injury was found in those with preoperative HbA1c< 6.0% rather than those with preoperative HbA1c≥6.0%〔RR=0.40, 95%CI (0.18, 0.92) , P=0.03〕, in those with preoperative HbA1c<6.5% rather than those with preoperative HbA1c≥6.5%〔RR=0.78, 95%CI (0.71, 0.84) , P<0.000 01〕, in those with preoperative HbA1c<7.0% rather than those with preoperative HbA1c≥7.0%〔RR=0.66, 95%CI (0.55, 0.78) , P<0.000 01〕, in those with preoperative HbA1c<7.5% rather than those with preoperative HbA1c≥7.5%〔RR=0.73, 95%CI (0.65, 0.82) , P<0.000 01〕, or in those with preoperative HbA1c<8.0% rather than those with preoperative HbA1c ≥8.0%〔RR=0.75, 95%CI (0.67, 0.84) , P<0.000 01〕. A shorter mean length of stay was found in those with preoperative HbA1c< 6.0% rather than those with preoperative HbA1c≥6.0%〔MD=-0.61, 95%CI (-1.23, 0.00) , P=0.05〕, in those with preoperative HbA1c<6.5% rather than those with preoperative HbA1c≥6.5%〔MD=-0.93, 95%CI (-1.58, -0.29) , P=0.005〕, or in those with preoperative HbA1c<7.0% rather than those with preoperative HbA1c≥7.0%〔MD=-0.81, 95%CI (-1.11, -0.51) , P<0.000 01〕. Conclusion Existing evidence shows that preoperative HbA1c less than 5.5% can effectively reduce early postoperative mortality of adult cardiac surgery patients. Better control of preoperative HbA1c level may be associated with reduced risk of postoperative complications and improved prognosis. Therefore, attention should be paid to the patient's HbA1c before cardiac surgery. For those with high HbA1c, it is suggested to take interventions to reduce blood glucose preoperatively in accordance with clinical manifestations and functions of organs if it is necessary.
Keywords
