Perioperative factors associated with hyperglycemia after pediatric cardiac surgery and impact of hyperglycemia on morbidity and mortality

Özet

This retrospective, observational, single-center study aimed to determinethe perioperative factors associated with postoperative hyperglycemia (bloodglucose level ≥126 mg/dl) and the impact of hyperglycemia on morbidity andmortality in a cohort of children undergoing cardiac surgery. Non-diabeticchildren aged between 1 month to 18 years who were consecutively admittedto pediatric intensive care unit (PICU) after cardiac surgery for congenitalheart disease between January 2008 and December 2013 were included.One hundred and twenty-six patients were qualified for inclusion during thestudy period. Seventy-four (57.8%) of the patients had at least one glucosemeasurement ≥ 126 mg/dl. Higher PRISM III-24 (OR 1.1, 95% CI 1.02-1.18, p= 0.004) and PELOD (p=0.006) scores, higher Wernovsky inotropicscore (p=0.027) and vasoactive-inotropic score (p=0.029) were associatedwith hyperglycemia. Postoperative hyperglycemia was not associated withduration of mechanical ventilation), length of PICU stay, healthcare associatedinfections, or mortality. Our study establishes that hyperglycemia is commonafter pediatric cardiac surgery but not associated with short-term morbidityand mortality. Insulin therapy can be accomplished without hypoglycemiawhen a permissive glycemic target is used. A large prospective multipleinstitution trial is necessary to facilitate defined guidelines for postoperativehyperglycemia after pediatric cardiac surgery.