ObjectiveTo explore the relationship between glycated hemoglobin (HbA1c) level and blood glucose fluctuations after coronary artery bypass grafting (CABG) and adverse events in non-diabetic patients, thus providing theoretical support for intensive preoperative blood glucose management in patients undergoing CABG surgery.MethodsA total of 304 patients undergoing CABG with or without valvular surgery from October 2013 to December 2017 were enrolled in this prospective, single-center, observational cohort study. We classified them into two different groups which were a low-level group and a high-level group according to the HbA1c level. There were 102 males and 37 females, aged 36–85 (61.5±9.5) years in the low-level group, and 118 males and 47 females aged 34–85 (63.1±9.4) years in the high-level group. The main results were different in hospital mortality and perioperative complications including in-hospital death, myocardial infarction, sternal incision infection, new stroke, new-onset renal failure and multiple organ failure. To assess the effects of confounding factors, multivariate logistic regression analysis was used.Results Postoperative blood glucose fluctuation was more pronounced in the high-level group than that in the low-level group before admission [0.8 (0.6, 1.2) mmol/L vs. 1.0 (0.8, 1.8) mmol/L, P<0.01]. This study also suggested that the incidence of major adverse events was significantly lower in the low-level group compared with the high-level group (P=0.001). Multivariate logistic regression analyses to correct the influence of other confounding factors showed that HbA1c (OR=2.773, P=0.002) and postoperative blood glucose fluctuations (OR=3.091, P<0.001) could still predict the occurrence of postoperative adverse events.ConclusionHbA1c on admission can effectively predict blood glucose fluctuations in 24 hours after surgery. Secondly, HbA1c on admission and postoperative blood glucose fluctuations can further predict postoperative adverse events. It is suggested that we control the patient's preoperative HbA1c at a low level, which is beneficial to control postoperative blood glucose fluctuation and postoperative adverse events.
Objective To investigate the correlation between D-dimer level within 2 hours on admission and early in-hospital major adverse events (MAEs) in patients with acute type A aortic dissection undergoing arch replacement and the frozen elephant trunk (FET) implantation. Methods The patients with acute type A aortic dissection undergoing arch replacement and the FET implantation, who hospitalized in our hospital from September 2017 to December 2022, were included in this retrospective study. Grouping based on the occurrence of in-hospital major adverse events (MAEs) after total arch replacement and FET implantation, with no in-hospital MAEs as a control group and in-hospital MAEs as an observation group. The perioperative data were compared between the two groups. Univariate and multivariate analyses were used to investigate the risk factors for MAEs (in-hospital mortality, gastrointestinal bleeding, paraplegia, acute kidney failure, reopening the chest, low cardiac output syndrome, cerebrovascular accident, respiratory insufficiency, multiple organ dysfunctionsyndrome, gastrointestinal bleeding, and severe infection). Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the prediction area under the ROC curve (AUC). Results Finally 218 patients were collected, including 157 males and 61 females with an average age of 51.54±9.79 years. There were 152 patients in the control group and 66 patients in the observation group. In-hospital mortality was 2.8% (6/218). The level of D-dimer, lactic acid, cardiopulmonary bypass time, aortic cross-clamping time, ventilator-assisted time and ICU stay in the observation group were higher or longer than those in the control group (P=0.013). Multivariate logistic analysis showed that D-dimer (OR=1.077, 95%CI 1.020-1.137, P＜0.05) was an independent risk factor for MAEs in hospital. The level of D-dimer within 2 hours admission predicted that the AUC of MAEs in hospital was 0.83 (95%CI 0.736-0.870, P＜0.05), and the optimal critical point was 2.2 μg/mL, with sensitivity and specificity of 84.8% and 73.0%, respectively. Conclusion Increased D-dimer levels at admission are associated with early in-hospital MAEs in the patients with acute type A aortic dissection undergoing arch replacement and FET. These results may help clinicians optimize the risk evaluation and perioperative clinical management to reduce early adverse events.