title: Admission hyperglycemia is associated with poor outcome after emergent coronary bypass grafting surgery.
abstract: OBJECTIVE
  Hyperglycemia during or after cardiac surgery is a common finding that is associated with poor outcome. Very few data, however, are available regarding a correlation between admission blood glucose and outcomes after coronary artery bypass grafting (CABG). Thus, the goal of the current study was to examine the relationship between admission blood glucose and outcome after emergency CABG surgery.
  
  
  METHODS
  A retrospective analysis to evaluate whether admission hyperglycemia associated with increased morbidity or mortality was performed in patients after emergency CABG surgery. The records of all the patients undergoing emergency CABG surgery between January 1999 and December 2010 at the University of Virginia Health System were reviewed. Postoperative in-hospital mortality and complications were considered as study end points.
  
  
  RESULTS
  A total of 240 patients met the final inclusion criteria. Overall mortality was 14.1%. The median admission blood glucose in patients who died 7.4 (interquartile range, 5.9-10.1) mmol/L was significantly higher compared with survivors 6.1 (interquartile range, 5.4-7.2; P<.01). Furthermore, 59% of the patients who died had admission blood glucose levels higher than 6.6 mmol/L, whereas only 35% of the patients who survived had similar blood glucose levels (P=.01). On multivariable analysis, admission blood glucose was identified as an independent risk factor for death after emergency CABG (P=.01; odds ratio, 1.16; 95% confidence interval, 1.04-1.29). Admission blood glucose was further identified as independently associated with increased risk for a composite outcome of death, postoperative renal failure or stroke (P=.01; odds ratio, 1.14; 95% confidence interval, 1.03-1.27).
  
  
  CONCLUSIONS
  Our study shows for the first time that admission blood glucose is correlated with increased morbidity and mortality among patients undergoing emergency CABG surgery.
authors.affiliation: Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Thiele
authors.affiliation: Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA; Department of Anesthesiology, University of Muenster, Muenster, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hucklenbruch
authors.affiliation: Department of Biostatistics and Epidemiology, University of Virginia Health System, Charlottesville, VA.
authors.forename: Jennie Z
authors.initials: JZ
authors.lastname: Ma
authors.affiliation: Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Colquhoun
authors.affiliation: Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA.
authors.forename: Zhiyi
authors.initials: Z
authors.lastname: Zuo
authors.affiliation: Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Nemergut
authors.affiliation: Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA. Electronic address: jr5ef@virginia.edu.
authors.forename: Jacob
authors.initials: J
authors.lastname: Raphael
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000401:mortality; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D016017:Odds Ratio; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose
keywords: Cardiac surgery; Coronary artery disease; Glucose; Insulin; Mortality; Myocardial ischemia