Leucoglycemic index predicts post-operative vasopressor-inotropic requirement after adult cardiac surgery (LEUCOGLYPTICS): A retrospective single-center study.

Background And Aims: Cardiac surgery often necessitates considerable post-operative vasoactive-inotropic support. Given an encouraging literature on the prognostic potential of leucoglycemic index (LGI) [serum glucose (mg/dl) × total leucocytes count (cells/mm)/1000], we aimed to evaluate whether intensive care unit (ICU)-admission LGI can predict post-operative vasopressor-inotropic requirements following cardiac surgery on cardio-pulmonary bypass (CPB).

Material And Methods: The data of patients undergoing cardiac surgery at our tertiary care center between January 2015 and December 2020 was retrospectively reviewed. The vasopressor-inotropic requirement was estimated using the VIS (vasoactive-inotropic score) values over the first post-operative 72 hrs. Subsequently, VIS (indexed VIS) was computed as maxVIS + maxVIS +2 × maxVIS/10), and the study participants were divided into h-VIS (VIS ≥3) and l-VIS (VIS <3).

Results: Out of 2138 patients, 479 (22.40%) patients categorized as h-VIS. On univariate analysis: LGI, age, European System for Cardiac Operative Risk Evaluation score (EuroSCORE II), left-ventricle ejection fraction, prior congestive heart failure (CHF), chronic renal failure, angiotensin-converting enzyme inhibitors, combined surgeries, CPB and aortic cross-clamp (ACC) duration, blood transfusion, and immediate post-operative glucose were significant h-VIS predictors. Subsequent to multi-variate analysis, the predictive performance of LGI (OR: 1.09; 95% CI: 1.03-1.14; = 0.002) prior CHF (OR: 2.35; 95% CI: 1.44-3.82; = 0.001), CPB time (OR: 1.08; 95% CI: 1.02-1.14; = 0.019), ACC time (OR: 1.03; 95% CI: 1.02-1.04; = 0.008), and EuroSCORE II (OR: 1.14; 95% CI: 1.06-1.21; < 0.001) remained significant. With 1484.75 emerging as the h-VIS predictive cut-off, patients with LGI ≥ 1484.75 also had a higher incidence of vasoplegia, low-cardiac output syndrome, new-onset atrial fibrillation, acute kidney injury, and mortality. LGI additionally exhibited a significant positive correlation with duration of mechanical ventilation and ICU stay (R = 0.495 and 0.564, value < 0.001).

Conclusion: An elevated LGI of greater than 1484.75 independently predicted a VISindex ≥3 following adult cardiac surgery on CPB.