Postoperative cardiac complications high among patients with poor blood glucose control

Poor blood glucose control following cardiac surgery is a predictor of in-hospital morbidity and mortality.

Researchers from Bristol Heart Institute in the United Kingdom evaluated patients who had cardiac surgery between April 1996 and March 2004 to determine the effect of poor blood glucose control on clinical outcomes.

The study included 8,727 patients who were categorized by blood glucose control: good (<200 mg/dL; n=7,547), moderate (200 to 250 mg/dL; n=905) or poor (>250 mg/dL; n=365).

New York Heart Association class, congestive heart failure, hypertension, renal dysfunction and ejection fraction <50% were most likely among patients with poor blood glucose control (P<.001). The researchers reported diabetes among 52% of patients with poor, 31% with moderate and 8% with good blood glucose control.

In-hospital mortality was related to poor blood glucose control but not diabetes (good: 1.8%; moderate: 4.2%; poor: 9.6%). Deaths occurred in 131 (1.8%) of the good, 38 (4.2%) of the moderate and 35 (9.6%) of the poor blood glucose control groups (P<.001). Transient ischemic attacks and gastrointestinal complications occurred most often in the poor blood glucose control group, and patients in this group had longer lengths of stay in ICU and postoperative care (P<.001).

Inadequate blood glucose control was related to MI (poor vs. good OR: 2.73; 95% CI, 1.74 to 4.26), and pulmonary (poor vs. good OR: 2.27; 95% CI, 1.65 to 3.12) and renal complications (poor vs. good OR: 2.82; 95% CI, 1.54 to 5.14) in those without known diabetes, according to the study. – by Stacey L. Adams

Circulation. 2008;118:113-123.