ArticlePloS one2018
Wider perioperative glycemic fluctuations increase risk of postoperative atrial fibrillation and ICU length of stay.
Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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10 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Glycemic variability and the risk of atrial fibrillation: a meta-analysis.Frontiers in endocrinology · 2023Pooled it
- The effect of dexmedetomidine on intraoperative blood glucose homeostasis: secondary analysis of a randomized controlled trial.BMC anesthesiology · 2021Trial
- Association of glycemic variability with the risk of new-onset atrial fibrillation and death in critically ill patients without diabetes: analysis of the MIMIC-IV database.Diabetology & metabolic syndrome · 2026Article
- Relationship between stress hyperglycemia ratio and the incidence of atrial fibrillation in patients after coronary artery bypass grafting: a retrospective study based on the MIMIC-IV database.Diabetology & metabolic syndrome · 2025Article
- Prognostic value of glycaemic variability for mortality in critically ill atrial fibrillation patients and mortality prediction model using machine learning.Cardiovascular diabetology · 2024Observational
- The impact of glucagon-like peptide-1 receptor agonists in the patients undergoing anesthesia or sedation: systematic review and meta-analysis.Perioperative medicine (London, England) · 2024Article
- Dysglycemia and arrhythmias.World journal of diabetes · 2023Review
- Exploring postoperative atrial fibrillation after non-cardiac surgery: mechanisms, risk factors, and prevention strategies.Frontiers in cardiovascular medicine · 2023Review
- Expert consensus on the glycemic management of critically ill patients.Journal of intensive medicine · 2022Article
- Practice Guidelines for Enteral Nutrition Management in Dysglycemic Critically Ill Patients: A Relook for Indian Scenario.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2019Article
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Authors and funding
4 authors at 3 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
introductionPostoperative atrial fibrillation (POAF) is a common complication following cardiac surgery associated with increased morbidity and mortality. Although sustained hyperglycemia is a known risk factor of AF and poor ICU outcomes, emerging in-vitro studies reveal acute glycemic fluctuations to be an additional independent predictor of AF. The effect of acute glycemic fluctuations on the incidence of POAF in the clinical setting remains unclear. We aim to investigate the effect of the magnitude of acute perioperative glycemic fluctuations on the incidence of POAF in a multi-ethnic Southeast-Asian population.
methodsWe obtained data from1743 patients who underwent elective CABG in a tertiary heart centre from 2009-2011. Patients were kept to a tight baseline glycemic control in accordance with hospital protocol. The magnitude of the difference between the highest and lowest perioperative glucose levels up till the first 48 postoperative hours was employed as a measure of glycemic fluctuation. Patients were divided into 4 groups for analysis based on the magnitude of glycemic fluctuation:A)0-2mmol/L(N = 147); B)>2-4mmol/L(N = 426); C)>4-6mmol/L(N = 513); D)>6mmol/L(N = 657).Our primary outcome was the incidence of POAF. Secondary outcomes included ICU and 30-day mortality and length of stay.
resultsThe overall incidence of POAF was 14.7%. This increased as the magnitude of glycemic fluctuation increased, and was statistically highest in Group D(16.4%) as compared with the other 3 sub-groups. Multivariate logistic regression revealed the magnitude of perioperative glycemic fluctuation to be an independent risk factor of POAF(O.R.1.06, 95% C.I.1.01-1.11, p = 0.014).ICU length of stay was statistically highest in Group D(63.1 hours, p = < .001). However, ICU and 30 day mortality rates were similar among the 4 groups.
conclusionIncreased magnitudes of acute perioperative glycemic fluctuations are associated with a significantly increased risk of POAF and length of ICU stay; and should therefore be minimised but balanced against the risks of hypoglycemia so as to avoid POAF and optimise patient outcomes.
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