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Published in: BMC Cardiovascular Disorders 1/2022

Open Access 01-12-2022 | Heart Surgery | Research

Effect of CPB glucose levels on inflammatory response after pediatric cardiac surgery

Authors: Zhi-Hua Zeng, Xin-Yi Yu, Xiao-Cheng Liu, Zhi-Gang Liu

Published in: BMC Cardiovascular Disorders | Issue 1/2022

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Abstract

Background

Systemic inflammatory response syndrome (SIRS) is a common complication after cardiac surgery. There are no definite optimal glycemic threshold for pediatric patients receiving open-heart surgery with CPB. The study aimed to investigate the optimal cardiopulmonary bypass (CPB) glucose in patients undergoing cardiac surgery.

Methods

We enrolled children with congenital heart disease who underwent surgical repair between June 2012 and December 2020. We included only patients who underwent cardiac surgery with CPB. The primary outcome was severe SIRS. A two-piece-wise regression model was applied to examine threshold effect of CPB glucose on severe SIRS.

Results

A total of 7350 patients were enrolled in the present study, of whom 3895 (52.99%) are female. After potential confounders were adjusted, non-linear relationship was detected between CPB glucose and severe SIRS, whose turning point was 8.1. With CPB glucose < 8.1 mmol/L, the estimated dose–response curve was consistent with a horizontal line. However, the prevalence of severe SIRS increased with increasing glucose up to the turning point (Glucose > 8.1 mmol/L); the odds ratio (OR) of the Glucose was 1.35 (95% CI 1.21, 1.50).

Conclusions

The present study indicates the association of CPB glucose with inflammatory response after pediatric cardiac surgery. The patients might have the best outcomes with the optimal CPB glucose no more than 8.1 mmol/L.
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Literature
1.
go back to reference Kruszka P. Beaton A The state of congenital heart disease. Am J Med Genet C Sem Med Genet. 2020;184(1):5–6.CrossRef Kruszka P. Beaton A The state of congenital heart disease. Am J Med Genet C Sem Med Genet. 2020;184(1):5–6.CrossRef
2.
go back to reference O’Brien SM, Clarke DR, Jacobs JP, Jacobs ML, Lacour-Gayet FG, Pizarro C, Welke KF, Maruszewski B, Tobota Z, Miller WJ, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg. 2009;138(5):1139–53.CrossRef O’Brien SM, Clarke DR, Jacobs JP, Jacobs ML, Lacour-Gayet FG, Pizarro C, Welke KF, Maruszewski B, Tobota Z, Miller WJ, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg. 2009;138(5):1139–53.CrossRef
3.
go back to reference Boehne M, Sasse M, Karch A, Dziuba F, Horke A, Kaussen T, Mikolajczyk R, Beerbaum P, Jack T. Systemic inflammatory response syndrome after pediatric congenital heart surgery: Incidence, risk factors, and clinical outcome. J Card Surg. 2017;32(2):116–25.CrossRef Boehne M, Sasse M, Karch A, Dziuba F, Horke A, Kaussen T, Mikolajczyk R, Beerbaum P, Jack T. Systemic inflammatory response syndrome after pediatric congenital heart surgery: Incidence, risk factors, and clinical outcome. J Card Surg. 2017;32(2):116–25.CrossRef
4.
go back to reference Doenst T, Wijeysundera D, Karkouti K, Zechner C, Maganti M, Rao V, Borger MA. Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2005;130(4):1144.CrossRef Doenst T, Wijeysundera D, Karkouti K, Zechner C, Maganti M, Rao V, Borger MA. Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2005;130(4):1144.CrossRef
5.
go back to reference Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, Williams BA, Schrader LM, Rizza RA, McMahon MM. Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clin Proc. 2005;80(7):862–6.CrossRef Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, Williams BA, Schrader LM, Rizza RA, McMahon MM. Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clin Proc. 2005;80(7):862–6.CrossRef
6.
go back to reference Yates AR, Dyke PC 2nd, Taeed R, Hoffman TM, Hayes J, Feltes TF, Cua CL. Hyperglycemia is a marker for poor outcome in the postoperative pediatric cardiac patient. Pediatr Crit Care Med. 2006;7(4):351–5.CrossRef Yates AR, Dyke PC 2nd, Taeed R, Hoffman TM, Hayes J, Feltes TF, Cua CL. Hyperglycemia is a marker for poor outcome in the postoperative pediatric cardiac patient. Pediatr Crit Care Med. 2006;7(4):351–5.CrossRef
7.
go back to reference Matsumoto S, Omiya H, Fujinaka W, Morimatsu H. Association between intraoperative hyperglycemia and postoperative end-organ dysfunctions after cardiac surgery: a retrospective observational study. J Anesth. 2021;36:174–84.CrossRef Matsumoto S, Omiya H, Fujinaka W, Morimatsu H. Association between intraoperative hyperglycemia and postoperative end-organ dysfunctions after cardiac surgery: a retrospective observational study. J Anesth. 2021;36:174–84.CrossRef
8.
go back to reference Vlasselaers D, Mesotten D, Langouche L, Vanhorebeek I, van den Heuvel I, Milants I, Wouters P, Wouters P, Meyns B, Bjerre M, et al. Tight glycemic control protects the myocardium and reduces inflammation in neonatal heart surgery. Ann Thorac Surg. 2010;90(1):22–9.CrossRef Vlasselaers D, Mesotten D, Langouche L, Vanhorebeek I, van den Heuvel I, Milants I, Wouters P, Wouters P, Meyns B, Bjerre M, et al. Tight glycemic control protects the myocardium and reduces inflammation in neonatal heart surgery. Ann Thorac Surg. 2010;90(1):22–9.CrossRef
9.
go back to reference Polito A, Thiagarajan RR, Laussen PC, Gauvreau K, Agus MS, Scheurer MA, Pigula FA, Costello JM. Association between intraoperative and early postoperative glucose levels and adverse outcomes after complex congenital heart surgery. Circulation. 2008;118(22):2235–42.CrossRef Polito A, Thiagarajan RR, Laussen PC, Gauvreau K, Agus MS, Scheurer MA, Pigula FA, Costello JM. Association between intraoperative and early postoperative glucose levels and adverse outcomes after complex congenital heart surgery. Circulation. 2008;118(22):2235–42.CrossRef
10.
go back to reference Liu H, Hu YJ, Zheng SQ, Chen T, Zeng ZH, Wu DD, Zhao S, Zeng B, Liu ZG, Shao YF. Effect of perfusate oxygenation on inflammatory response in congenital heart disease children from low versus high altitude. J Thorac Cardiovasc Surg. 2021;161(6):2180–90.CrossRef Liu H, Hu YJ, Zheng SQ, Chen T, Zeng ZH, Wu DD, Zhao S, Zeng B, Liu ZG, Shao YF. Effect of perfusate oxygenation on inflammatory response in congenital heart disease children from low versus high altitude. J Thorac Cardiovasc Surg. 2021;161(6):2180–90.CrossRef
11.
go back to reference Chakraborty RK, Burns B. Systemic inflammatory response syndrome. In: StatPearls. edn. Treasure Island (FL): StatPearls Publishing LLC; 2022. Chakraborty RK, Burns B. Systemic inflammatory response syndrome. In: StatPearls. edn. Treasure Island (FL): StatPearls Publishing LLC; 2022.
12.
go back to reference Menon K, Schlapbach LJ, Akech S, Argent A, Chiotos K, Chisti MJ, Hamid J, Ishimine P, Kissoon N, Lodha R, et al. Pediatric sepsis definition-a systematic review protocol by the pediatric sepsis definition taskforce. Crit Care Explor. 2020;2(6):e0123.CrossRef Menon K, Schlapbach LJ, Akech S, Argent A, Chiotos K, Chisti MJ, Hamid J, Ishimine P, Kissoon N, Lodha R, et al. Pediatric sepsis definition-a systematic review protocol by the pediatric sepsis definition taskforce. Crit Care Explor. 2020;2(6):e0123.CrossRef
13.
go back to reference Qizilbash N, Gregson J, Johnson ME, Pearce N, Douglas I, Wing K, Evans SJW, Pocock SJ. BMI and risk of dementia in two million people over two decades: a retrospective cohort study. Lancet Diabetes Endocrinol. 2015;3(6):431–6.CrossRef Qizilbash N, Gregson J, Johnson ME, Pearce N, Douglas I, Wing K, Evans SJW, Pocock SJ. BMI and risk of dementia in two million people over two decades: a retrospective cohort study. Lancet Diabetes Endocrinol. 2015;3(6):431–6.CrossRef
14.
go back to reference Song L, Fan D, Cun L, Jinping L, Ju Z, Zhengyi F. Effects of peri-operative glucose levels on adverse outcomes in infants receiving open-heart surgery for congenital heart disease with cardiopulmonary bypass. Perfusion. 2011;26(2):133–9.CrossRef Song L, Fan D, Cun L, Jinping L, Ju Z, Zhengyi F. Effects of peri-operative glucose levels on adverse outcomes in infants receiving open-heart surgery for congenital heart disease with cardiopulmonary bypass. Perfusion. 2011;26(2):133–9.CrossRef
15.
go back to reference Moorthy V, Sim MA, Liu W, Chew STH, Ti LK. Risk factors and impact of postoperative hyperglycemia in nondiabetic patients after cardiac surgery: a prospective study. Medicine. 2019;98(23):e15911.CrossRef Moorthy V, Sim MA, Liu W, Chew STH, Ti LK. Risk factors and impact of postoperative hyperglycemia in nondiabetic patients after cardiac surgery: a prospective study. Medicine. 2019;98(23):e15911.CrossRef
16.
go back to reference Shah NJ, Leis A, Kheterpal S, Englesbe MJ, Kumar SS. Association of intraoperative hyperglycemia and postoperative outcomes in patients undergoing non-cardiac surgery: a multicenter retrospective study. BMC Anesthesiol. 2020;20(1):106.CrossRef Shah NJ, Leis A, Kheterpal S, Englesbe MJ, Kumar SS. Association of intraoperative hyperglycemia and postoperative outcomes in patients undergoing non-cardiac surgery: a multicenter retrospective study. BMC Anesthesiol. 2020;20(1):106.CrossRef
17.
go back to reference Vlasselaers D, Milants I, Desmet L, Wouters PJ, Vanhorebeek I, van den Heuvel I, Mesotten D, Casaer MP, Meyfroidt G, Ingels C, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet. 2009;373(9663):547–56.CrossRef Vlasselaers D, Milants I, Desmet L, Wouters PJ, Vanhorebeek I, van den Heuvel I, Mesotten D, Casaer MP, Meyfroidt G, Ingels C, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet. 2009;373(9663):547–56.CrossRef
Metadata
Title
Effect of CPB glucose levels on inflammatory response after pediatric cardiac surgery
Authors
Zhi-Hua Zeng
Xin-Yi Yu
Xiao-Cheng Liu
Zhi-Gang Liu
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2022
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-022-02667-w

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