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Intraoperative hyperglycemia in patients with an elevated preoperative C-reactive protein level may increase the risk of acute kidney injury after cardiac surgery

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A Letter to the Editor to this article was published on 09 April 2021

Abstract

Purpose

The effect of hyperglycemia on acute kidney injury (AKI) in patients undergoing cardiac surgery is unclear and may involve as yet unexplored factors. We hypothesized differential effects of intraoperative hyperglycemia on AKI after cardiac surgery depending on baseline inflammatory status, as reflected by the C-reactive protein (CRP) level.

Methods

This retrospective study included patients who underwent cardiac surgery seen at our hospital from 2008 to 2018. Patients were classified into four groups according to their preoperative CRP level (≥ 1 or < 1 mg/dl) and their intraoperative time-weighted average glucose concentration (> 140 or ≤ 140 mg/dl): low CRP and normoglycemia, low CRP and hyperglycemia, high CRP and normoglycemia, and high CRP and hyperglycemia. The data were analyzed by multivariable logistic regression analysis.

Results

The data of 3625 patients were analyzed. The logistic regression showed that patients in the high CRP and hyperglycemia group had a significantly higher risk of AKI than patients in the low CRP and normoglycemia group [odds ratio (OR), 1.58; 95% confidence interval (CI) 1.10–2.27], low CRP with hyperglycemia group (OR, 1.69; 95% CI 1.16–2.47) and high CRP with normoglycemia group (OR, 1.50; 95% CI 1.01–2.23).

Conclusions

Intraoperative hyperglycemia in patients with an elevated preoperative CRP level was significantly related to an increased risk of AKI after cardiac surgery. Individualized perioperative glycemic control may therefore be necessary in these patients.

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Acknowledgements

We specially thank Mr. Younghae Cho, B.S. (from the Department of Statistics, Sungkyunkwan University, Seoul, Korea) for his significant contribution to the statistical analyses of this work.

This study used clinical data retrieved from the Seoul National University Hospital Patients Research Environment (SUPREME) system.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea

    Seohee Lee, Seungpyo Nam, Jinyoung Bae, Youn Joung Cho, Yunseok Jeon & Karam Nam

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Contributions

Conceptualization: SL, YJ, and KN; Formal analysis and investigation: SL, SN, JB, YJC, and KN; Writing—original draft preparation: SL, SN, JB, YJC, and KN; Writing—review and editing: SN, JB, YJC, and KN; Supervision: YJ.

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Correspondence to Karam Nam.

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Electronic supplementary material

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540_2020_2849_MOESM1_ESM.tif

Online Resource 1. Restricted cubic splines curve showing the log-odds for AKI following cardiac surgery according to preoperative CRP level. Three knots set at 10, 50, and 90 percentiles. AKI acute kidney injury, CRP C-reactive protein (TIF 443 kb)

540_2020_2849_MOESM2_ESM.tif

Online Resource 2. Restricted cubic splines curve showing the log-odds for AKI following cardiac surgery according to intraoperative TWAG. Three knots set at 10, 50, and 90 percentiles. AKI acute kidney injury, TWAG time-weighted average glucose concentration (TIF 480 kb)

Online Resource 3. Logistic regression analyses for acute kidney injury after cardiac surgery (DOCX 22 kb)

Online Resource 4. Multivariable logistic regression analyses stratified by preoperative Hemoglobin A1c (DOCX 15 kb)

Online Resource 5. Multivariable logistic regression performed using data of the last 5 years (DOCX 15 kb)

540_2020_2849_MOESM6_ESM.docx

Online Resource 6. Multivariable logistic regression performed in a subgroup where emergent surgeries were not included (DOCX 14 kb)

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Lee, S., Nam, S., Bae, J. et al. Intraoperative hyperglycemia in patients with an elevated preoperative C-reactive protein level may increase the risk of acute kidney injury after cardiac surgery. J Anesth 35, 10–19 (2021). https://doi.org/10.1007/s00540-020-02849-w

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