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Published in: Journal of Cardiothoracic Surgery 1/2024

Open Access 01-12-2024 | CABG | Research

Association between HbA1c and deep sternal wound infection after coronary artery bypass: a systematic review and meta-analysis

Authors: Wenyu Zhao, Jingui Xie, Zhichao Zheng, Han Zhou, Oon Cheong Ooi, Haidong Luo

Published in: Journal of Cardiothoracic Surgery | Issue 1/2024

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Abstract

Background

Deep sternal wound infection (DSWI) constitutes a serious complication after coronary artery bypass grafting (CABG) surgery. The aim of this study is to evaluate the dose-response relationship between glycated hemoglobin (HbA1c) level and the risk of DSWI after CABG.

Methods

PubMed, Scopus, and Cochrane Library databases were searched to identify potentially relevant articles. According to rigorous inclusion and exclusion criteria, fourteen studies including 15,570 patients were enrolled in our meta-analysis. Odds ratio (OR) with 95% confidence intervals (CIs) was used as the summary statistic. The robust-error meta-regression model was used to synthesize the dose-response relationship.

Results

Our meta-analysis shows that among patients undergoing CABG, preoperative elevated HbA1c was associated with the risk of developing DSWI (OR = 2.67, 95% CI 2.00–3.58) but with low prognostic accuracy (diagnostic OR = 2.70, 95% CI 1.96–3.73; area under the curve = 0.66, 95% CI 0.62–0.70) for predicting postoperative DSWI. Subgroup analyses showed the relationship became nonsignificant in patients without diabetes and studies adopting lower HbA1c thresholds. Dose-response analysis showed a significant nonlinear (p = 0.03) relationship between HbA1c and DSWI, with a significantly increased risk of DSWI when HbA1c was > 5.7%.

Conclusions

An elevated HbA1c level of > 5.7% was related to a higher risk of developing DSWI after CABG, and the risk increased as the HbA1c level grew. The association between HbA1c and DSWI was nonsignificant among nondiabetic patients while significant among diabetic patients.
Literature
1.
go back to reference Vrancic JM, Piccinini F, Camporrotondo M, Espinoza JC, Camou JI, Nacinovich F, et al. Bilateral internal thoracic artery grafting increases mediastinitis: myth or fact? Ann Thorac Surg. 2017;103(3):834–9.CrossRefPubMed Vrancic JM, Piccinini F, Camporrotondo M, Espinoza JC, Camou JI, Nacinovich F, et al. Bilateral internal thoracic artery grafting increases mediastinitis: myth or fact? Ann Thorac Surg. 2017;103(3):834–9.CrossRefPubMed
2.
go back to reference Kubota H, Miyata H, Motomura N, Ono M, Takamoto S, Harii K, et al. Deep sternal wound infection after cardiac surgery. J Cardiothorac Surg. 2013;8:132.CrossRefPubMedPubMedCentral Kubota H, Miyata H, Motomura N, Ono M, Takamoto S, Harii K, et al. Deep sternal wound infection after cardiac surgery. J Cardiothorac Surg. 2013;8:132.CrossRefPubMedPubMedCentral
3.
go back to reference Risnes I, Abdelnoor M, Almdahl SM, Svennevig JL. Mediastinitis after coronary artery bypass grafting risk factors and long-term survival. Ann Thorac Surg. 2010;89:1502–9.CrossRefPubMed Risnes I, Abdelnoor M, Almdahl SM, Svennevig JL. Mediastinitis after coronary artery bypass grafting risk factors and long-term survival. Ann Thorac Surg. 2010;89:1502–9.CrossRefPubMed
4.
go back to reference Furui M, Kong PK, Moorthy PSK, et al. Risk factors for Sternal Wound Infection after coronary artery bypass grafting in patients with and without Diabetes[J]. Int Heart J. 2022;63(3):426–32.CrossRefPubMed Furui M, Kong PK, Moorthy PSK, et al. Risk factors for Sternal Wound Infection after coronary artery bypass grafting in patients with and without Diabetes[J]. Int Heart J. 2022;63(3):426–32.CrossRefPubMed
5.
go back to reference Iannantuoni F, Diaz-Morales N, Escribano-Lopez I, Sola E, Roldan-Torres I, Apostolova N, et al. Does glycemic control modulate the impairment of nlrp3 inflammasome activation in type 2 diabetes? Antioxid Redox Signal. 2019;30:232–40.CrossRefPubMed Iannantuoni F, Diaz-Morales N, Escribano-Lopez I, Sola E, Roldan-Torres I, Apostolova N, et al. Does glycemic control modulate the impairment of nlrp3 inflammasome activation in type 2 diabetes? Antioxid Redox Signal. 2019;30:232–40.CrossRefPubMed
7.
go back to reference Škrha J, Šoupal J, Prázný M. Glucose variability, hba1c and microvascular complications. Rev Endocr Metab Disord. 2016;17:103–10.CrossRefPubMed Škrha J, Šoupal J, Prázný M. Glucose variability, hba1c and microvascular complications. Rev Endocr Metab Disord. 2016;17:103–10.CrossRefPubMed
8.
go back to reference Writing Committee Members, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice guidelines. Circulation. 2011;124(23):e652–e735. Writing Committee Members, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice guidelines. Circulation. 2011;124(23):e652–e735.
9.
go back to reference Nicolini F, Santarpino G, Gatti G, Reichart D, Onorati F, Faggian G, et al. Utility of glycated hemoglobin screening in patients undergoing elective coronary artery surgery: prospective, cohort study from the e-cabg registry. Int J Surg. 2018;53:354–59.CrossRefPubMed Nicolini F, Santarpino G, Gatti G, Reichart D, Onorati F, Faggian G, et al. Utility of glycated hemoglobin screening in patients undergoing elective coronary artery surgery: prospective, cohort study from the e-cabg registry. Int J Surg. 2018;53:354–59.CrossRefPubMed
10.
go back to reference Narayan P, Kshirsagar SN, Mandal CK, Ghorai PA, Rao YM, Das D, et al. Preoperative glycosylated hemoglobin: a risk factor for patients undergoing coronary artery bypass. Ann Thorac Surg. 2017;104:606–12.CrossRefPubMed Narayan P, Kshirsagar SN, Mandal CK, Ghorai PA, Rao YM, Das D, et al. Preoperative glycosylated hemoglobin: a risk factor for patients undergoing coronary artery bypass. Ann Thorac Surg. 2017;104:606–12.CrossRefPubMed
11.
go back to reference Stang A. Critical evaluation of the newcastle-ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.CrossRefPubMed Stang A. Critical evaluation of the newcastle-ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.CrossRefPubMed
13.
go back to reference Xu C, Doi SAR. The robust error meta-regression method for dose-response meta-analysis. Int J Evid Based Healthc. 2018;16:138–44.CrossRefPubMed Xu C, Doi SAR. The robust error meta-regression method for dose-response meta-analysis. Int J Evid Based Healthc. 2018;16:138–44.CrossRefPubMed
14.
15.
go back to reference Xu W, Tan CC, Zou JJ, Cao XP, Tan L. Sleep problems and risk of all-cause cognitive decline or dementia: an updated systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2020;91:236–44.CrossRefPubMed Xu W, Tan CC, Zou JJ, Cao XP, Tan L. Sleep problems and risk of all-cause cognitive decline or dementia: an updated systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2020;91:236–44.CrossRefPubMed
16.
go back to reference Blondet JJ, Beilman GJ. Glycemic control and prevention of perioperative infection. Curr Opin Crit Care. 2007;13:421–7.CrossRefPubMed Blondet JJ, Beilman GJ. Glycemic control and prevention of perioperative infection. Curr Opin Crit Care. 2007;13:421–7.CrossRefPubMed
17.
go back to reference Zheng J, Cheng J, Wang T, Zhang Q, Xiao X. Does hba1c level have clinical implications in diabetic patients undergoing coronary artery bypass grafting? A systematic review and meta-analysis. Int J Endocrinol. 2017;2017:1537213.CrossRefPubMedPubMedCentral Zheng J, Cheng J, Wang T, Zhang Q, Xiao X. Does hba1c level have clinical implications in diabetic patients undergoing coronary artery bypass grafting? A systematic review and meta-analysis. Int J Endocrinol. 2017;2017:1537213.CrossRefPubMedPubMedCentral
18.
go back to reference Engoren M, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, et al. The prevalence of elevated hemoglobin a1c in patients undergoing coronary artery bypass surgery. J Cardiothorac Surg. 2008;3:63.CrossRefPubMedPubMedCentral Engoren M, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, et al. The prevalence of elevated hemoglobin a1c in patients undergoing coronary artery bypass surgery. J Cardiothorac Surg. 2008;3:63.CrossRefPubMedPubMedCentral
19.
go back to reference Göksedef D, Ömeroğlu S, Yalvaç E, Bitargil M, İpek G. Is elevated HbA1c a risk factor for infection after coronary artery bypass grafting surgery. Turk J Thorac Cardiovasc Surg. 2010;18:252–8. Göksedef D, Ömeroğlu S, Yalvaç E, Bitargil M, İpek G. Is elevated HbA1c a risk factor for infection after coronary artery bypass grafting surgery. Turk J Thorac Cardiovasc Surg. 2010;18:252–8.
20.
go back to reference Matsuura K, Imamaki M, Ishida A, Shimura H, Niitsuma Y, Miyazaki M. Off-pump coronary artery bypass grafting for poorly controlled diabetic patients. Ann Thorac Cardiovasc Surg. 2009;15:18–22.PubMed Matsuura K, Imamaki M, Ishida A, Shimura H, Niitsuma Y, Miyazaki M. Off-pump coronary artery bypass grafting for poorly controlled diabetic patients. Ann Thorac Cardiovasc Surg. 2009;15:18–22.PubMed
21.
go back to reference Enginoev S, Rad AA, Ekimov S, et al. Risk factors for Deep Sternal Wound Infection after off-pump coronary artery bypass grafting: a case-control Study[J]. Brazilian J Cardiovasc Surg. 2021;37:13–9. Enginoev S, Rad AA, Ekimov S, et al. Risk factors for Deep Sternal Wound Infection after off-pump coronary artery bypass grafting: a case-control Study[J]. Brazilian J Cardiovasc Surg. 2021;37:13–9.
22.
go back to reference American Diabetes Association. Standards of medical care in diabetes-2020 abridged for primary care providers. Clin Diabetes. 2020;38:10–38.CrossRefPubMedCentral American Diabetes Association. Standards of medical care in diabetes-2020 abridged for primary care providers. Clin Diabetes. 2020;38:10–38.CrossRefPubMedCentral
23.
go back to reference World Health Organization. Use of glycated haemoglobin (HbA1c) in diagnosis of diabetes mellitus: abbreviated report of a WHO consultation. World Health Organization; 2011. No. WHO/NMH/CHP/CPM/11.1. World Health Organization. Use of glycated haemoglobin (HbA1c) in diagnosis of diabetes mellitus: abbreviated report of a WHO consultation. World Health Organization; 2011. No. WHO/NMH/CHP/CPM/11.1.
25.
go back to reference Subramaniam B, Lerner A, Novack V, Khabbaz K, Paryente-Wiesmann M, Hess P, et al. Increased glycemic variability in patients with elevated preoperative hba1c predicts adverse outcomes following coronary artery bypass grafting surgery. Anesth Analg. 2014;118:277–87.CrossRefPubMed Subramaniam B, Lerner A, Novack V, Khabbaz K, Paryente-Wiesmann M, Hess P, et al. Increased glycemic variability in patients with elevated preoperative hba1c predicts adverse outcomes following coronary artery bypass grafting surgery. Anesth Analg. 2014;118:277–87.CrossRefPubMed
26.
go back to reference Biancari F, Giordano S. Glycated hemoglobin and the risk of sternal wound infection after adult cardiac surgery: a systematic review and meta-analysis. Semin Thorac Cardiovasc Surg. 2019;31:465–7.CrossRefPubMed Biancari F, Giordano S. Glycated hemoglobin and the risk of sternal wound infection after adult cardiac surgery: a systematic review and meta-analysis. Semin Thorac Cardiovasc Surg. 2019;31:465–7.CrossRefPubMed
27.
go back to reference Elsisy MF, Stulak JM, Alkhouli M. Incidence, characteristics, and outcomes of emergent isolated coronary artery bypass grafting. Am J Cardiol. 2020;137:20–4.CrossRefPubMed Elsisy MF, Stulak JM, Alkhouli M. Incidence, characteristics, and outcomes of emergent isolated coronary artery bypass grafting. Am J Cardiol. 2020;137:20–4.CrossRefPubMed
28.
go back to reference Button KS, Ioannidis JP, Mokrysz C, Nosek BA, Flint J, Robinson ES, Munafò MR. Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci. 2013;14:365–76.CrossRefPubMed Button KS, Ioannidis JP, Mokrysz C, Nosek BA, Flint J, Robinson ES, Munafò MR. Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci. 2013;14:365–76.CrossRefPubMed
29.
go back to reference McGinn JT, Shariff MA, Bhat TM, Azab B, Molloy WJ, Quattrocchi E, et al. Prevalence of dysglycemia among coronary artery bypass surgery patients with no previous diabetic history. J Cardiothorac Surg. 2011;6:104.CrossRefPubMedPubMedCentral McGinn JT, Shariff MA, Bhat TM, Azab B, Molloy WJ, Quattrocchi E, et al. Prevalence of dysglycemia among coronary artery bypass surgery patients with no previous diabetic history. J Cardiothorac Surg. 2011;6:104.CrossRefPubMedPubMedCentral
30.
go back to reference Alserius T, Anderson RE, Hammar N, Nordqvist T, Ivert T. Elevated glycosylated haemoglobin (hba1c) is a risk marker in coronary artery bypass surgery. Scand Cardiovasc J. 2008;42:392–8.CrossRefPubMed Alserius T, Anderson RE, Hammar N, Nordqvist T, Ivert T. Elevated glycosylated haemoglobin (hba1c) is a risk marker in coronary artery bypass surgery. Scand Cardiovasc J. 2008;42:392–8.CrossRefPubMed
31.
go back to reference Halkos ME, Puskas JD, Lattouf OM, Kilgo P, Kerendi F, Song HK, et al. Elevated preoperative hemoglobin a1c level is predictive of adverse events after coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2008;136:631–40.CrossRefPubMed Halkos ME, Puskas JD, Lattouf OM, Kilgo P, Kerendi F, Song HK, et al. Elevated preoperative hemoglobin a1c level is predictive of adverse events after coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2008;136:631–40.CrossRefPubMed
32.
go back to reference Tsuruta R, Miyauchi K, Yamamoto T, Dohi S, Tambara K, Dohi T, et al. Effect of preoperative hemoglobin a1c levels on long-term outcomes for diabetic patients after off-pump coronary artery bypass grafting. J Cardiol. 2011;57:181–6.CrossRefPubMed Tsuruta R, Miyauchi K, Yamamoto T, Dohi S, Tambara K, Dohi T, et al. Effect of preoperative hemoglobin a1c levels on long-term outcomes for diabetic patients after off-pump coronary artery bypass grafting. J Cardiol. 2011;57:181–6.CrossRefPubMed
33.
go back to reference Gumus F, Polat A, Sinikoglu SN, Yektas A, Erkalp K, Alagol A. Use of a lower cut-off value for hba1c to predict postoperative renal complication risk in patients undergoing coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 2013;27:1167–73.CrossRefPubMed Gumus F, Polat A, Sinikoglu SN, Yektas A, Erkalp K, Alagol A. Use of a lower cut-off value for hba1c to predict postoperative renal complication risk in patients undergoing coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 2013;27:1167–73.CrossRefPubMed
34.
go back to reference Santos JM, Favaloro RR, Lowenstein D, Sanabria H, Raffaelli H, Hershson A. Medium-term glycemic control in diabetics before coronary bypass surgery. Med (B Aires). 2015;75:277–81. Santos JM, Favaloro RR, Lowenstein D, Sanabria H, Raffaelli H, Hershson A. Medium-term glycemic control in diabetics before coronary bypass surgery. Med (B Aires). 2015;75:277–81.
35.
go back to reference Ramadan M, Abdelgawad A, Elshemy A, Sarawy E, Emad A, Mazen M, et al. Impact of elevated glycosylated hemoglobin on hospital outcome and 1 year survival of primary isolated coronary artery bypass grafting patients. Egypt Heart J. 2018;70:113–18.CrossRefPubMed Ramadan M, Abdelgawad A, Elshemy A, Sarawy E, Emad A, Mazen M, et al. Impact of elevated glycosylated hemoglobin on hospital outcome and 1 year survival of primary isolated coronary artery bypass grafting patients. Egypt Heart J. 2018;70:113–18.CrossRefPubMed
36.
go back to reference Almogati JG, Ahmed EO. Glycated hemoglobin as a predictor of the length of hospital stay in patients following coronary bypass graft surgery in the Saudi population. Braz J Cardiovasc Surg. 2019;34:28–32.CrossRefPubMedPubMedCentral Almogati JG, Ahmed EO. Glycated hemoglobin as a predictor of the length of hospital stay in patients following coronary bypass graft surgery in the Saudi population. Braz J Cardiovasc Surg. 2019;34:28–32.CrossRefPubMedPubMedCentral
37.
go back to reference Kim HJ, Shim JK, Youn YN, Song JW, Lee H, Kwak YL. Influence of preoperative hemoglobin a1c on early outcomes in patients with diabetes mellitus undergoing off-pump coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2020;159:568–76.CrossRefPubMed Kim HJ, Shim JK, Youn YN, Song JW, Lee H, Kwak YL. Influence of preoperative hemoglobin a1c on early outcomes in patients with diabetes mellitus undergoing off-pump coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2020;159:568–76.CrossRefPubMed
Metadata
Title
Association between HbA1c and deep sternal wound infection after coronary artery bypass: a systematic review and meta-analysis
Authors
Wenyu Zhao
Jingui Xie
Zhichao Zheng
Han Zhou
Oon Cheong Ooi
Haidong Luo
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2024
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/s13019-024-02549-6

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