Different measurements of stress hyperglycaemia and their relationship with post-cardiac surgery outcomes.

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Hyperglycaemia in hospitalised patients is independently associated with increased morbidity and mortality in a wide range of patient groups, including post-operative outcomes. The association between hyperglycaemia and poor post-operative outcomes is strong in patients without diabetes, but a weaker predictor in patients with diabetes. This discrepancy is in part driven by the difficulty in distinguishing genuine stress hyperglycaemia from chronic high levels seen in diabetic patients. A high plasma glucose concentration in a hospitalised patient can occur because of chronic poor diabetes control and be “normal” for that patient, represent a transient physiologic response to an inter¬current illness (stress hyperglycaemia), or be a combination of the above. A metric for stress hyperglycaemia has been developed at FMC - the Stress Hyperglycaemia Ratio is defined as glucose concentration divided by the Estimated Average Glucose concentration, which is calculated from HbA1c. This enables quantification of the relative change in hyperglycaemia eg a patient with a SHR of 1.4 has an glucose concentration 40% higher than their average glucose over the prior 3 months. Our previous work indicated that the relative change in glucose was a better indicator of stress hyperglycaemia and more strongly associated with adverse patient outcomes than glucose. This initial work was in a broad general hospital population. This study aims to determine the clinical applicability of the Stress Hyperglycaemia Ratio to post-op outcomes for patients undergoing CABG surgery. This group requires mandatory post-op observation in the ICU setting, and commonly require intervention for glucose management. We aim to determine if the Stress Hyperglycaemia Ratio is more strongly associated with adverse post-op outcomes in this group than glucose alone.

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