Association of Preoperative Hemoglobin A1c with In-hospital Mortality Following Valvular Heart Surgery

Abstract Objective: To determine the association between the preoperative level of hemoglobin A1c (HbA1c) and in-hospital mortality in patients who underwent valvular heart surgery in our center in a retrospective cohort. Methods: In this retrospective consecutive cohort study, patients with type 2 diabetes mellitus who were referred to our center for elective valvular surgery were enrolled and followed up. The endpoint of this study was in-hospital mortality. Based on the level of HbA1c, patients were dichotomized around a level of 7% into two groups: exposed patients with HbA1c ≥ 7% and unexposed patients with HbA1c < 7%. Then, the study variables were compared between the two groups. Results: Two hundred twenty-four diabetic patients who were candidates for valvular surgery were enrolled; 106 patients (47.3%) had HbA1c < 7%, and 118 patients (52.6%) had HbA1c ≥ 7%. The duration of diabetes was higher in patients with HbA1c ≥ 7% (P=0.007). Thirteen (5.8%) patients died during hospital admission, of which nine patients were in the high HbA1c group. There was no significant difference between the groups regarding in-hospital mortality (P=0.899). Both the unadjusted and adjusted logistic regression models showed that HbA1c was not a predictor for in-hospital mortality (P=0.227 and P=0.388, respectively) Conclusion: This study showed no association between preoperative HbA1c levels and in-hospital mortality in candidates for valvular heart surgery.

摘要：研究目的：本回顾性队列研究旨在明确本中心接受心脏瓣膜手术患者的术前糖化血红蛋白A1c（hemoglobin A1c, HbA1c）水平与院内死亡率之间的关联。方法：本项回顾性连续性队列研究纳入了转诊至本中心行择期心脏瓣膜手术的2型糖尿病患者，并对其进行随访。本研究的终点事件为院内死亡率。以7%为截点将患者按糖化血红蛋白A1c水平分为两组：HbA1c≥7%的暴露组与HbA1c<7%的非暴露组。随后对两组间的研究变量进行比较。结果：本研究共纳入224例拟行心脏瓣膜手术的糖尿病患者，其中106例（47.3%）患者HbA1c<7%，118例（52.6%）患者HbA1c≥7%。HbA1c≥7%组患者的糖尿病病程更长（P=0.007）。共有13例（5.8%）患者住院期间死亡，其中9例来自高HbA1c组。两组患者的院内死亡率无显著差异（P=0.899）。未校正与校正后的logistic回归模型均显示，HbA1c并非院内死亡率的预测因素（分别为P=0.227与P=0.388）。结论：本研究表明，拟行心脏瓣膜手术患者的术前HbA1c水平与院内死亡率无关联。