Relationship between glycemic variability and the incidence of postoperative atrial fibrillation following cardiac Surgery: A retrospective study from MIMIC-IV database

Aims: This study aimed to explore the association between glycemic variability (GV) and postoperative atrial fibrillation (POAF) incidence.

Methods: In this retrospective study, we included patients undergoing cardiac surgeries. GV was calculated as the coefficient of variation of blood glucose and categorized into tertiles based on its distribution. The primary endpoint was the incidence of POAF. Logistic regression and restricted cubic splines were used to assess the relationship between GV and POAF.

Results: 5365 patients were included, with a median age of 68.3 years, and 25.5 % were female. 1056 (19.7 %) patients developed new-onset POAF. Compared with the low GV group, moderate GV group (odds ratio [OR], 1.82; 95 % confidence interval [CI]: 1.49-2.22) and high GV group (OR, 2.25; 95 % CI, 1.80-2.82) were significantly associated with a higher incidence of POAF. The area under the receiver operating characteristic curve of GV in predicting POAF incidence was 0.77 (95 % CI: 0.76-0.79). There is a threshold-based nonlinear relationship between GV and the incidence of POAF: when GV was < 24 %, the likelihood of POAF increases with higher GV, whereas when GV ≥ 24 %, further increases did not significantly affect the risk of POAF.

Conclusions: Increased GV is associated with higher incidence of POAF.