Research Article: Wider perioperative glycemic fluctuations increase risk of postoperative atrial fibrillation and ICU length of stay

Date Published: June 8, 2018

Publisher: Public Library of Science

Author(s): Ming Ann Sim, Weiling Liu, Sophia T. H. Chew, Lian Kah Ti, Cesario Bianchi.

http://doi.org/10.1371/journal.pone.0198533

Abstract

Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery associated with increased morbidity and mortality. Although sustained hyperglycemia is a known risk factor of AF and poor ICU outcomes, emerging in-vitro studies reveal acute glycemic fluctuations to be an additional independent predictor of AF. The effect of acute glycemic fluctuations on the incidence of POAF in the clinical setting remains unclear. We aim to investigate the effect of the magnitude of acute perioperative glycemic fluctuations on the incidence of POAF in a multi-ethnic Southeast-Asian population.

We obtained data from1743 patients who underwent elective CABG in a tertiary heart centre from 2009–2011. Patients were kept to a tight baseline glycemic control in accordance with hospital protocol. The magnitude of the difference between the highest and lowest perioperative glucose levels up till the first 48 postoperative hours was employed as a measure of glycemic fluctuation. Patients were divided into 4 groups for analysis based on the magnitude of glycemic fluctuation:A)0-2mmol/L(N = 147); B)>2-4mmol/L(N = 426); C)>4-6mmol/L(N = 513); D)>6mmol/L(N = 657).Our primary outcome was the incidence of POAF. Secondary outcomes included ICU and 30-day mortality and length of stay.

The overall incidence of POAF was 14.7%. This increased as the magnitude of glycemic fluctuation increased, and was statistically highest in Group D(16.4%) as compared with the other 3 sub-groups. Multivariate logistic regression revealed the magnitude of perioperative glycemic fluctuation to be an independent risk factor of POAF(O.R.1.06, 95% C.I.1.01–1.11, p = 0.014).ICU length of stay was statistically highest in Group D(63.1 hours, p = < .001). However, ICU and 30 day mortality rates were similar among the 4 groups. Increased magnitudes of acute perioperative glycemic fluctuations are associated with a significantly increased risk of POAF and length of ICU stay; and should therefore be minimised but balanced against the risks of hypoglycemia so as to avoid POAF and optimise patient outcomes.

Partial Text

Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery, occurring in up to 10–60% of cardiac-surgical patients, associated with significantly increased morbidity and mortality rates [1,2].

We obtained data from a total of 1743 patients who underwent elective CABG at the Singapore General Hospital from 2009–2011. The overall incidence of POAF was 14.7%.

Postoperative atrial fibrillation is a common occurrence in post-cardiac surgery patients, and contributes significantly to mortality and morbidity [14]. Our incidence rate of 14.7% was similar to that reported in previous studies [1].

We conclude that greater perioperative glycemic fluctuations are an independent risk factor for the development of postoperative atrial fibrillation in patients undergoing coronary artery bypass graft surgery.

 

Source:

http://doi.org/10.1371/journal.pone.0198533

 

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