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

• Main Authors: ZHAO, Wenyu, XIE, Jingui, ZHENG, Zhichao, ZHOU, Han, OOI, Oon Cheong, LUO, Haidong
• Format: text
• Language: English
• Published: Institutional Knowledge at Singapore Management University 2024
• Subjects: HbA1c; deep sternal wound infection; DSWI; CABG; dose-response; meta-analysis; Medical Sciences; Operations and Supply Chain Management
• Online Access: https://ink.library.smu.edu.sg/lkcsb_research/7465; https://ink.library.smu.edu.sg/context/lkcsb_research/article/8464/viewcontent/s13019_024_02549_6.pdf
• Institution: Singapore Management University

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 finally 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%.ConclusionsAn elevated HbA1c level of >5.7% is related to a higher risk of developing DSWI after CABG, and the risk is increasing as the HbA1c level grows. The association between HbA1c and DSWI was nonsignificant among nondiabetic patients while significant among diabetic patients.