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ELEVATED GLYCOSYLATED HEMOGLOBIN IS HARBINGER OF ADVERSE SHORT-TERM OUTCOMES FOLLOWING CORONARY ARTERY BYPASS GRAFTING

Objective: To determine the association of elevated HbA1c levels with length of ICU stay, prolonged mechanical ventilator and ionotropic support, and infections in diabetic patients undergoing CABG. 
Methodology: This Prospective cohort study was conducted at National Institute of Cardiovascular Diseases, Karachi. One hundred fifty eight (158) diabetic patients were enrolled fulfilling inclusion criteria. Data was classified into two groups, Exposed group: elevated HbA1c (≥7%) and Un-exposed group: HbA1c (<7%) and study outcomes in both groups were compared for any statistically significant difference. 
Results: Total 86.1% patients had prolonged ICU duration, 79.7% (p<0.001) had prolonged mechanical ventilator and 87.3% (p<0.001) patients with prolonged ionotropic support in Exposed group (elevated HbA1c). In Un-exposed group (controlled HbA1c), 44.3% patients had prolonged ICU duration, 12.7% patients had prolonged mechanical ventilator and 64.6% had prolonged ionotropic support. In group-A, 35.4% were observed with sepsis, 16.5% with pneumonia and 31.6% (p=0.026) were with urinary tract infection while in group-B, 49.4% were with sepsis, 16.5% pneumonia and 16.5% urinary tract infection. 
Conclusion: Elevated HbA1c level is risk marker for higher rate of infections and hospital length of stay after CABG. An HbA1c of 7% or greater was found to be a strong predictor of a length of ICU stay, ventilator support and adverse short-term outcomes including urinary tract infections.