La variabilité glycémique peropératoire, et non la concentration glycémique moyenne, pourrait être un facteur de risque d’insuffisance rénale aiguë après une chirurgie cardiaque

une étude rétrospective

Translated title of the contribution: Intraoperative glucose variability, but not average glucose concentration, may be a risk factor for acute kidney injury after cardiac surgery: a retrospective study

Karam Nam Nam, Yunseok Jeon, Won Ho Kim, Dhong Eun Jung, Seok Min Kwon, Pyoyoon Kang, Youn Joung Cho, Tae Kyong Kim

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Purpose: Altered perioperative glycemic control may contribute to the development of renal dysfunction in cardiac surgery patients. Nevertheless, whether it is intraoperative hyperglycemia or increased glucose variability that affects postoperative outcomes is not yet clear. The aim of this study was to assess the association of intraoperative glucose concentration and variability with acute kidney injury (AKI) after cardiac surgery. Methods: We retrospectively reviewed the electronic medical records of 3,598 patients who underwent cardiac surgery between November 1, 2006 to December 31, 2016. The time-weighted average glucose (TWAG) and coefficient of variation of glucose measurements were both used as measures of intraoperative glucose control with multivariable logistic regression to evaluate their relationship to postoperative AKI. Results: The intraoperative glucose coefficient of variation was an independent risk factor for AKI after cardiac surgery (highest quartile odds ratio, 1.38; 95% confidence interval, 1.09 to 1.75; P = 0.01). Nevertheless, the intraoperative TWAG did not remain in the final multivariable model of postoperative AKI. Conclusion: Intraoperative glucose variability, but not the average glucose concentration itself, may be a risk factor for AKI after cardiac surgery.

Original languageFrench
Pages (from-to)921-933
Number of pages13
JournalCanadian Journal of Anesthesia
Volume66
Issue number8
DOIs
StatePublished - 15 Aug 2019

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Acute Kidney Injury
Thoracic Surgery
Retrospective Studies
Glucose
Electronic Health Records
Hyperglycemia
Logistic Models
Odds Ratio
Confidence Intervals
Kidney

Cite this

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title = "La variabilit{\'e} glyc{\'e}mique perop{\'e}ratoire, et non la concentration glyc{\'e}mique moyenne, pourrait {\^e}tre un facteur de risque d’insuffisance r{\'e}nale aigu{\"e} apr{\`e}s une chirurgie cardiaque: une {\'e}tude r{\'e}trospective",
abstract = "Purpose: Altered perioperative glycemic control may contribute to the development of renal dysfunction in cardiac surgery patients. Nevertheless, whether it is intraoperative hyperglycemia or increased glucose variability that affects postoperative outcomes is not yet clear. The aim of this study was to assess the association of intraoperative glucose concentration and variability with acute kidney injury (AKI) after cardiac surgery. Methods: We retrospectively reviewed the electronic medical records of 3,598 patients who underwent cardiac surgery between November 1, 2006 to December 31, 2016. The time-weighted average glucose (TWAG) and coefficient of variation of glucose measurements were both used as measures of intraoperative glucose control with multivariable logistic regression to evaluate their relationship to postoperative AKI. Results: The intraoperative glucose coefficient of variation was an independent risk factor for AKI after cardiac surgery (highest quartile odds ratio, 1.38; 95{\%} confidence interval, 1.09 to 1.75; P = 0.01). Nevertheless, the intraoperative TWAG did not remain in the final multivariable model of postoperative AKI. Conclusion: Intraoperative glucose variability, but not the average glucose concentration itself, may be a risk factor for AKI after cardiac surgery.",
author = "Nam, {Karam Nam} and Yunseok Jeon and Kim, {Won Ho} and Jung, {Dhong Eun} and Kwon, {Seok Min} and Pyoyoon Kang and Cho, {Youn Joung} and Kim, {Tae Kyong}",
year = "2019",
month = "8",
day = "15",
doi = "10.1007/s12630-019-01349-0",
language = "French",
volume = "66",
pages = "921--933",
journal = "Canadian Journal of Anesthesia",
issn = "0832-610X",
publisher = "Springer New York",
number = "8",

}

TY - JOUR

T1 - La variabilité glycémique peropératoire, et non la concentration glycémique moyenne, pourrait être un facteur de risque d’insuffisance rénale aiguë après une chirurgie cardiaque

T2 - une étude rétrospective

AU - Nam, Karam Nam

AU - Jeon, Yunseok

AU - Kim, Won Ho

AU - Jung, Dhong Eun

AU - Kwon, Seok Min

AU - Kang, Pyoyoon

AU - Cho, Youn Joung

AU - Kim, Tae Kyong

PY - 2019/8/15

Y1 - 2019/8/15

N2 - Purpose: Altered perioperative glycemic control may contribute to the development of renal dysfunction in cardiac surgery patients. Nevertheless, whether it is intraoperative hyperglycemia or increased glucose variability that affects postoperative outcomes is not yet clear. The aim of this study was to assess the association of intraoperative glucose concentration and variability with acute kidney injury (AKI) after cardiac surgery. Methods: We retrospectively reviewed the electronic medical records of 3,598 patients who underwent cardiac surgery between November 1, 2006 to December 31, 2016. The time-weighted average glucose (TWAG) and coefficient of variation of glucose measurements were both used as measures of intraoperative glucose control with multivariable logistic regression to evaluate their relationship to postoperative AKI. Results: The intraoperative glucose coefficient of variation was an independent risk factor for AKI after cardiac surgery (highest quartile odds ratio, 1.38; 95% confidence interval, 1.09 to 1.75; P = 0.01). Nevertheless, the intraoperative TWAG did not remain in the final multivariable model of postoperative AKI. Conclusion: Intraoperative glucose variability, but not the average glucose concentration itself, may be a risk factor for AKI after cardiac surgery.

AB - Purpose: Altered perioperative glycemic control may contribute to the development of renal dysfunction in cardiac surgery patients. Nevertheless, whether it is intraoperative hyperglycemia or increased glucose variability that affects postoperative outcomes is not yet clear. The aim of this study was to assess the association of intraoperative glucose concentration and variability with acute kidney injury (AKI) after cardiac surgery. Methods: We retrospectively reviewed the electronic medical records of 3,598 patients who underwent cardiac surgery between November 1, 2006 to December 31, 2016. The time-weighted average glucose (TWAG) and coefficient of variation of glucose measurements were both used as measures of intraoperative glucose control with multivariable logistic regression to evaluate their relationship to postoperative AKI. Results: The intraoperative glucose coefficient of variation was an independent risk factor for AKI after cardiac surgery (highest quartile odds ratio, 1.38; 95% confidence interval, 1.09 to 1.75; P = 0.01). Nevertheless, the intraoperative TWAG did not remain in the final multivariable model of postoperative AKI. Conclusion: Intraoperative glucose variability, but not the average glucose concentration itself, may be a risk factor for AKI after cardiac surgery.

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