Blood glucose management in the patient undergoing cardiac surgery: A review

Both diabetes mellitus and hyperglycemia per se are associated with negative outcomes after cardiac surgery. In this article, we review these associations, the possible mechanisms that lead to adverse outcomes, and the epidemiology of diabetes focusing on those patients requiring cardiac surgery. We also examine outpatient and perioperative management of diabetes with the same focus. Finally, we discuss our own efforts to improve glycemic management of patients undergoing cardiac surgery at our institution, including keys to success, results of implementation, and patient safety concerns.

Impact of neutrophil-to-lymphocyte ratio on the effect of hyperglycemia at admission on clinical outcomes after endovascular thrombectomy

Background:The neutrophil-to-lymphocyte ratio(NLR)is highly associated with stress responses to acute disorders and may be useful for differentiating hyperglycemia after stroke that is induced by stress or other causes.This study aims to evaluate whether the NLR modifies the effect of hyperglycemia at admission on clinical outcome after thrombectomy.Methods:We retrospectively enrolled 343 patients that underwent endovascular thrombectomy for acute anterior circulation large-vessel occlusion between January 2019 and June 2022.NLR at admission was used to dichotomize patients into low-NLR and high-NLR groups according to its median value.The primary outcome was 90-day functional independence(modified Rankin Scale Score 0–2).Secondary outcomes were 24 h symptomatic intracranial hemorrhage and 90-day mortality.Results:Overall,hyperglycemia at admission decreased the likelihood of functional independence(adjusted odds ratio[OR]:0.34,95%confidence interval[95%CI]:0.19–0.60,p<0.001).There was a significant interaction between the NLR and hyperglycemia at admission on functional independence(p=0.024).Hyperglycemia at admission was negatively associated with functional independence in low-NLR patients(adjusted OR:0.18,95%CI:0.07–0.42,p<0.001),but not in high-NLR patients(adjusted OR:0.67,95%CI:0.30–1.48,p=0.320).Interactions between the NLR and hyperglycemia at admission on 24 h symptomatic intracerebral hemorrhage(p=0.734)and 90-day mortality(p=0.657)were not significant.Conclusions:The NLR modified the detrimental effect of hyperglycemia at admission on functional independence after thrombectomy.Low-NLR patients with hyperglycemia were at a high risk of poor outcomes,and might more likely benefit from aggressive glucose-lowering treatment.