Register
Forgot your password?

Fructosamine as a marker for carbohydratemetabolism and its relationship with in-hospitaloutcomes after coronary artery bypass grafting

Authors: Bezdenezhnykh N.A.1, Sumin A.N.1, Bezdenezhnykh A.V.1, Osokina A.V.1, Kuz’mina A.A.1, Gruzdeva O.V.1, Barbarash O.L.1,2, 2

Company: 1 Research Institute for Complex Issues of Cardiovascular Diseases; Sosnovyy bul’var, 6, Kemerovo, 650002, Russian Federation;
 2 Kemerovo State Medical Institution; ulitsa Voroshilova, 22a, Kemerovo, 650056, Russian Federation

For correspondence:  Sign in or register.


DOI: https://doi.org/10.15275/kreatkard.2017.01.04

For citation: Bezdenezhnykh N.A., Sumin A.N., Bezdenezhnykh A.V., Osokina A.V., Kuz’mina A.A., Gruzdeva O.V., Barbarash O.L. Fructosamine as a marker for carbohydrate metabolism and its relationship with in-hospital outcomes after coronary artery bypass grafting. Kreativnaya kardiologiya (Creative Cardiology, Russian journal). 2017; 11 (1): 31–44 (in Russ.). DOI: 10.15275/kreatkard.2017.01.04

Received / Accepted:  March 06, 2017 / March 16, 2017

Keywords: fructosamine glycated hemoglobin diabetes coronary artery bypass surgery postoperative complications glycemic control

Download
Full text:  

 

Abstract

Objective. To assess the relationship between fructosamine levels, other parameters of carbohydrate metabolism and the rate of in-hospital complications after CABG in patients with type 2 diabetes.
Material and methods. 114 patients with type 2 diabetes mellitus (group 1) included in the study from the CABG Registry (708 patients undergoing CABG in 2011–2012 in cardiac surgery clinic Kemerovo). 114 patients without any documented disorders of carbohydrate metabolism (group 2) were comparable for age, gender and CABG characteristics. All patients underwent HbA1c and serum fructosamine measurement.
Results. The analysis of the in-hospital complications reported a significantly higher rate of the chest-related complications (p=0.02), primarily due to hydrothorax (p=0.005). There were no significant differences found in other complication rates. According to regression analysis markers of carbohydrate metabolism (glucose, HbA1c, fructosamine) were examined as potential predictors of in-hospital adverse events after CABG. Logistic regression didn’t reveal any associations of glucose level with postoperative complications. HbA1c was associated only with sternal wound complications (odds ratio (OR) 1.183, 95% confidence interval (CI) 1.024–1.618, p=0.033). Fructosamine was an independent predictor of sternal wound complications (OR 1.132 per 10 μmol/l increase, 95% CI 1.012–1.266, p=0.029) and chest-related complications (OR 1.747, 95% CI 1.045–2.920 for fructosamine levels ≥287.5 μmol/l, p=0.028).
Сonclusion. Serum fructosamine level is a significant predictor of the CABG complications in patients with diabetes and without diabetes.

References

  1. Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio–Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur. Heart J. 2014; 35 (37): 2541–619. DOI: 10.1093/eurheartj/ehu278.

  2. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, prediabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur. Heart J. 2013; 34 (39): 3035–87.

  3. D’Agostino R.S., Jacobs J.P., Badhwar V., Paone G., Rankin J.S., Han J.M. et al. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2016 Update on Outcomes and Quality. Ann. Thorac. Surg. 2016; 101 (1): 24–32. DOI: 10.1016/j.athoracsur.2015.11.032.

  4. Holzmann M.J., Rathsman B., Eliasson B., Kuhl J., Svensson A.M., Nyström T., Sartipy U. Long-term prognosis in patients with type 1 and 2 diabetes mellitus after coronary artery bypass grafting. J. Am. Coll. Cardiol. 2015; 65 (16): 1644–52. DOI: 10.1016/j.jacc.2015.02.052.

  5. Sumin А.N., Bezdenezhnykh N.А., Bezdenezh-nykh А.V., Ivanov S.V., Barbarash O.L. Peripheralatherosclerosis, diabetes and long-term resultsof coronary artery bypass grafting. CreativeCardiology. 2014; 4: 5–16 (in Russ.)

  6. American Diabetes Association. Standards of Medical Care in Diabetes 2016. Diabetes Care in the Hospital. Diabetes Care. 2016; 39 (Suppl. 1): S99–104. DOI: 10.2337/dc16-S016.

  7. Dedov I.I., Shestakova M.V. (Eds) Standards ofspecialized diabetes care. 7th ed. Diabetes mellitus.2015; 18 (1s): 1–112. DOI: 10.14341/dm20151s1-112 (in Russ.).

  8. Selvin E., Rawlings A.M., Grams M. et al. Prognostic utility of fructosamine and glycated albumin for incident diabetes and microvascular complications. Lancet Diabetes Endocrinol. 2014; 2 (4): 279–88. DOI: 10.1016/S2213-8587(13)70199-2.

  9. Danese E., Montagnana M., Nouvenne A., Lippi G. Advantages and pitfalls of fructosamine and glycated albumin in the diagnosis and treatment of diabetes. J. Diabetes Sci. Technol. 2015; 9 (2): 169–76. DOI: 10.1177/1932296814567227.

  10. Malmström H., Walldius G., Grill V., Jungner I., Hammar N. Fructosamine is a risk factor for myocardial infarction and all-cause mortality – Longitudinal experience from the AMORIS cohort. Nutr. Metab. Cardiovasc. Dis. 2015; 25 (10): 943–50. DOI: 10.1016/j.numecd.2015.07.002.

  11. Zaccardi F., Kurl S., Pitocco D., Ronkainen K., Laukkanen J.A. Serum fructosamine and risk of cardiovascular and all-cause mortality: a 24-year prospective population-based study. Nutr. Metab. Cardiovasc. Dis. 2015; 25 (2): 236–41. DOI: 10.1016/j.numecd.2014.09.007.

  12. Dedov I.I., Shestakova M.V. (Eds) Standards ofspecialized diabetes care. 5th ed. Diabetes mellitus.2011; 3 (1s): 1–72 (in Russ.)

  13. Gatti G., Perrotti A., Reichart D., Maschietto L., Onorati F., Chocron S. et al. Glycated hemoglobin and risk of sternal wound infection after isolated coronary surgery. Circ. J. 2016; 81 (1): 36–43. DOI: 10.1253/circj.CJ-16-0778.

  14. Sumin A.N., Bezdenezhnyh N.A., Ivanov S.V.,Barbarash O.L., Barbarash L.S. On the issue of therisk of postoperative complications of coronaryartery bypass grafting in patients with type 2 dia-betes. Byuletten’ Nauchnogo Tsentra Serdechno-Sosudistoy Khirurgii imeni A.N. Bakuleva RossiyskoyAkademii Meditsinskikh Nauk.2012; 5: 59–68(in Russ.).

  15. Tennyson C., Lee R., Attia R. Is there a role for HbA1c in predicting mortality and morbidity outcomes after coronary artery bypass graft surgery? Interact. Cardiovasc. Thorac. Surg. 2013; 17 (6): 1000–8. DOI: 10.1093/icvts/ivt351.

  16. Kuhl J., Sartipy U., Eliasson B., Nyström T., Holzmann M.J. Relationship between preoperative hemoglobin A1c levels and long-term mortality after coronary artery bypass grafting in patients with type 2diabetes mellitus. Int. J. Cardiol. 2016; 202: 291–6. DOI: 10.1016/j.ijcard.2015.09.008.

  17. Trubnikova O.A., Tarasova I.V., Mamontova A.S.,Kagan E.S., Maleva O.V., Barbarash O.L. Predic-tors of moderate cognitive disorders in patientswith coronary heart disease and type 2 diabetesmellitus. Klinicheskaya meditsina. 2016; 94 (1):31–5 (in Russ.).

  18. Chen X., Wu J., Li R., Wang Q., Tang Y., Shang X. The establishment of adult reference intervals on fructosamine in beijing. J. Clin. Lab. Anal. 2016; 30 (6): 1051–5. DOI: 10.1002/jcla.21979.

  19. Kalaria T.R., Sirajwala H.B., Gohel M.G. Serum fructosamine, serum glycated albumin and serum glycated β-lipoprotein in type 2 diabetes mellitus patients with and without microvascular complications J. Diabetes Metab. Disord. 2016; 15: 53. DOI: 10.1186/s40200-016-0276-0.

  20. Malmström H., Wändell P.E., Holzmann M.J., Ärnlöv J., Jungner I., Hammar N. et al. Low fructosamine and mortality – A long term follow-up of 215,011 non-diabetic subjects in the Swedish AMORIS study. Nutr. Metab. Cardiovasc. Dis. 2016; 26 (12): 1120–8. DOI: 10.1016/j.numecd.2016.08.006.

About Authors

  • Bezdenezhnykh Natal’ya Aleksandrovna, MD, PhD, Research Associate;
  • Sumin Aleksey Nikolaevich, MD, DM, Chief of Department;
  • Bezdenezhnykh Andrey Viktorovich, MD, PhD, Senior Research Associate;
  • Osokina Anastasiya Vyacheslavovna, MD, PhD, Senior Research Associate;
  • Kuz’mina Anastasiya Aleksandrovna, Junior Research Associate;
  • Gruzdevа Ol’ga Viktorovna, MD, DM, Chief of the Laboratory;
  • Barbarash Ol’ga Leonidovna, MD, DM, Professor, Corresponding Member of Russian Academy of Sciences, Director of Research Institute for Complex Issues of Cardiovascular Diseases, Chief of Chair of the Cardiology and Cardiovascular Surgery Department at the Kemerovo State Medical Academy of Ministry of Health of the Russian Federation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Sort by