Prognostic Value of the Leuko-Glycaemic Index in the Postoperative Period of Coronary Artery Bypass Grafting

Abstract Introduction: High leuko-glycaemic index (LGI) (> 2000) has been associated with poor prognosis in many critical care settings. However, there is no evidence of LGI's prognostic value in the postoperative period of coronary artery bypass grafting (CABG). This study aims to analyze the prognostic value of LGI in the postoperative period of CABG. Methods: Single-center retrospective analysis of prospectively collected data was performed. Consecutive adult patients undergoing CABG between 2007 and 2019 were included. Blood glucose levels and white blood cells count were evaluated in the immediate postoperative period. LGI was calculated by multiplying both values and dividing them by 1,000 and analyzed in quartiles. Receiver operating characteristic curve was used to determine the best cutoff value. The primary combined endpoint was in-hospital mortality, low cardiac output (LCO), or acute kidney injury (AKI). Secondary endpoints included in-hospital death, AKI, atrial fibrillation, and LCO. Results: The study evaluated 3,813 patients undergoing CABG (88.5% male, 89.8% off-pump surgery, aged 64.6 years [standard deviation 9.6]). The median of LGI was 2,035. Presence of primary endpoint significantly increased per LGI quartile (9.2%, 9.7%, 11.8%, and 15%; P<0.001). High LGI was associated with increased occurrence of in-hospital mortality, LCO, AKI, and atrial fibrillation. The best prognostic cutoff value for primary endpoint was 2,000. In a multivariate logistic regression model, high LGI was independently associated with in-hospital death, LCO, or AKI. Conclusion: High LGI was an independent predictor of in-hospital mortality, LCO, or AKI in postoperative period of CABG. It was also associated with higher in-hospital death.

Utilidad del electrocardiograma obtenido a través de una vía venosa central en pacientes críticos / Usefulness of the electrocardiogram obtained by means of a central venous catheter in critically ill patients

Cuando la onda P es difícil de identificar en el electrocardiograma de superficie puede recurrirse al registrointra esofágico o al registro intravascular obtenido a través de una vía venosa central llena con solución salina denominado electrocardiograma intravascular. El registro a través de una vía central llena de solución salina es simple, confortable y no requiere de la colaboración del paciente ni de equipos especiales para su realización. A pesar de las ventajas antes mencionadas, en la actualidad la mayoría de los médicos intensivistas o cardiólogosd es conoce la existencia de este recurso diagnóstico. En este trabajo se realiza una revisión de los distintos métodos electrocardiográficos disponibles para magnificar la actividad auricular con especial atención en el electrocardiograma intravascular.

Sometimes when the P wave is hard to identify in the surface electrocardiogram either the esophageal electrocardiogram (EECG) registry or the intracardiacregistry via a central venous catheter (IC-ECG) may beused. In contrast with the EECG, the recording made bythe IC-ECG is simple, comfortable and does not requirepatient cooperation nor the use of special equipment. Besides these advantages the IC-ECG is poorly knownand is underused in the intensive care setting. In this article, the author provides a description of the different existing electrocardiographic methods available tomagnify the atrial electrical activity with special focus onthe IC-ECG.