Stress hyperglycemia ratio as a marker of major postoperative complications after cardiac surgery with cardiopulmonary bypass.

Abstract

Purpose: This study examined whether the stress hyperglycemia ratio (SHR) at intensive care unit (ICU) admission is associated with major postoperative complications after cardiac surgery with cardiopulmonary bypass and whether this association differs from that of absolute ICU admission glucose.

Methods: This single-center retrospective study included 731 surgical episodes from 709 adults who underwent cardiac surgery with cardiopulmonary bypass. SHR was calculated as the first ICU glucose divided by HbA1c-derived estimated average glucose. The primary outcome was an unweighted composite of 30-day mortality, stroke, Kidney Disease: Improving Global Outcomes stage 3 acute kidney injury, reoperation for bleeding, prolonged mechanical ventilation, and deep sternal wound infection. Multivariable logistic regression adjusted for clinically relevant covariates.

Results: The composite outcome occurred in 90 surgical episodes (12.3%). SHR was associated with the composite outcome after adjustment (odds ratio [OR], 1.103 per 0.1 increase; 95% confidence interval [CI] 1.008-1.208; P = 0.033), whereas ICU admission glucose was not significantly associated (OR, 1.019 per 10 mg/dL increase; 95% CI 0.946-1.096; P = 0.626).

Conclusion: SHR at ICU admission was associated with major postoperative complications in the primary analysis, whereas absolute ICU admission glucose was not significantly associated after multivariable adjustment. Confidence intervals for SHR included 1.0 in several sensitivity analyses. SHR warrants prospective evaluation as an early postoperative risk marker after cardiac surgery with cardiopulmonary bypass.