Association between HbA1c and deep sternal wound infection after coronary artery bypass: a systematic review and meta-analysis.

Publisher: BioMed Central Country of Publication: England NLM ID: 101265113 Publication Model: Electronic Cited Medium: Internet ISSN: 1749-8090 (Electronic) Linking ISSN: 17498090 NLM ISO Abbreviation: J Cardiothorac Surg Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2006-

Coronary Artery Bypass*/adverse effects ; Diabetes Mellitus*; Humans ; Glycated Hemoglobin ; Risk Factors ; Surgical Wound Infection/etiology ; Sternum/surgery ; Retrospective Studies

Background: Deep sternal wound infection (DSWI) constitutes a serious complication after coronary artery bypass grafting (CABG) surgery. The aim of this study is to evaluate the dose-response relationship between glycated hemoglobin (HbA1c) level and the risk of DSWI after CABG.
Methods: PubMed, Scopus, and Cochrane Library databases were searched to identify potentially relevant articles. According to rigorous inclusion and exclusion criteria, fourteen studies including 15,570 patients were enrolled in our meta-analysis. Odds ratio (OR) with 95% confidence intervals (CIs) was used as the summary statistic. The robust-error meta-regression model was used to synthesize the dose-response relationship.
Results: Our meta-analysis shows that among patients undergoing CABG, preoperative elevated HbA1c was associated with the risk of developing DSWI (OR = 2.67, 95% CI 2.00-3.58) but with low prognostic accuracy (diagnostic OR = 2.70, 95% CI 1.96-3.73; area under the curve = 0.66, 95% CI 0.62-0.70) for predicting postoperative DSWI. Subgroup analyses showed the relationship became nonsignificant in patients without diabetes and studies adopting lower HbA1c thresholds. Dose-response analysis showed a significant nonlinear (p = 0.03) relationship between HbA1c and DSWI, with a significantly increased risk of DSWI when HbA1c was > 5.7%.
Conclusions: An elevated HbA1c level of > 5.7% was related to a higher risk of developing DSWI after CABG, and the risk increased as the HbA1c level grew. The association between HbA1c and DSWI was nonsignificant among nondiabetic patients while significant among diabetic patients.
(© 2024. The Author(s).)

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Keywords: CABG; DSWI; Deep sternal wound infection; Dose-response; HbA1c; Meta-analysis

0 (Glycated Hemoglobin)

Date Created: 20240204 Date Completed: 20240206 Latest Revision: 20240207

20240209

PMC10840199

10.1186/s13019-024-02549-6

38311780