Abstract 2080: Glycemic Profile in Infants: Are Postoperative Glucose Levels Associated With Adverse Events After Congenital Heart Surgery?
Background: Hyperglycemia occurs commonly and has been associated with increased morbidity and mortality in critically ill adults following cardiac surgery. However, limited data exist regarding the effect of glycemic profiles after congenital cardiac operations in infants, who are more reliant on glucose for energy use. The aim of this cohort study was to determine whether adjusted associations exist between postoperative glucose levels and adverse outcomes after infant cardiac surgery.
Methods: From 2007 through 2008, 702 consecutive infants (<12 months of age) underwent the congenital heart surgery. Serum glycemic profile, including average, peak and nadir of glucose levels during the first 72 postoperative hours was documented. Multivariable regression analyses were used to determine relationships between these glucose levels, a composite morbidity-mortality outcome (primary end point), and length of ICU stay after controlling for multiple variables known to influence early outcomes after congenital heart surgery.
Results: The nadir glucose <80 mg/dL (OR, 3.05; 95% CI, 1.58 to 6.34) or the average glucose <110 mg/dL (OR, 2.73; 95% CI, 1.31 to 4.58) were associated with greater adjusted odds of reaching the composite morbidity-mortality end point and length of ICU stay (P<0.01). The peak glucose >250 mg/dL or the average glucose >150 mg/dL were not associated with the composite morbidity-mortality end point but with longer ICU stays. Greater duration of glucose <110 mg/dL during the 72 postoperative hours was also associated with the composite morbidity-mortality end point longer duration of ICU stay (P<0.01). Greater duration of hyperglycemia (glucose >126 mg/dL) during the 72 postoperative hours did not reach the composite morbidity-mortality end point or longer duration of ICU stay.
Conclusions: Infants who spent the majority of the time with glucose values <110 mg/dL were at increased risk for adverse events and longer duration of ICU stay; and hyperglycemia does not appear to be detrimental in postoperative infants following cardiac surgery. Randomized trials are warranted to define the optimal glycemic profile in the postoperative cardiac infant population.