title: Use of a lower cut-off value for HbA1c to predict postoperative renal complication risk in patients undergoing coronary artery bypass grafting.
abstract: OBJECTIVE
  There is an increasing interest in reexamining the relationship between glucose levels and postoperative complications. Threshold levels of HbA1c below those currently recommended may be additional indicators of risk for renal and cardiovascular dysfunction. In this study, the authors analyzed the perioperative outcomes of coronary artery bypass graft (CABG) operations to evaluate the association of HbA1c levels and renal complications.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Research and training hospital, single institution.
  
  
  METHODS
  The prospectively collected data of 510 coronary bypass patients with documented HbA1c levels were analyzed.
  
  
  METHODS
  The relationship of HbA1c with postoperative renal morbidity was evaluated with logistic regression analysis with lower threshold value (5.9%) for elevated levels.
  
  
  RESULTS
  Two hundred ninety-three patients (57.5%) had elevated HbA1c values. Patients with high HbA1c levels (>5.9%) had higher incidences of atherosclerotic vascular diseases. The incidence of acute kidney injury was higher in the high HbA1c group (11.9% v 1.8%; p = 0.0001). The high HbA1c group had higher incidence of renal morbidity (odds ratio = 4.608), and every 1% increase over 5.9% increased risk of renal complications by 23.6%. The other factors associated with renal morbidity were known history of diabetes, chronic renal disease, and performance of any concomitant procedure.
  
  
  CONCLUSIONS
  The elevated levels of HbA1c are associated with increased renal complications and the cut-off values of HbA1c could be lowered to the upper range of normal limits.
authors.affiliation: Department of Anesthesia and Reanimation, Bagcilar Research and Training Hospital, Istanbul, Turkey. Electronic address: fgumus@hotmail.com.
authors.forename: Funda
authors.initials: F
authors.lastname: Gumus
authors.forename: Adil
authors.initials: A
authors.lastname: Polat
authors.forename: Sitki N
authors.initials: SN
authors.lastname: Sinikoglu
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Yektas
authors.forename: Kerem
authors.initials: K
authors.lastname: Erkalp
authors.forename: Aysin
authors.initials: A
authors.lastname: Alagol
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000401:mortality*; D003404:Creatinine / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D023381:Endpoint Determination; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D003404:Creatinine; D006442:Glycated Hemoglobin
keywords: CABG; Hemoglobin A1c; cardiac surgery; glucose; renal complication