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Impact of SGLT2 inhibitor continuation on fluid balance in cardiac surgery patients undergoing cardiopulmonary bypass? a single-center retrospective observational study
Position du problème et objectif(s) de l’étude
The perioperative management of sodium-glucose co-transporter 2 inhibitors (SGLT2i) in cardiac surgery with cardiopulmonary bypass (CPB) remains insufficiently studied. This study investigates the impact of continuing SGLT2i on postoperative fluid balance, acute kidney injury and ICU outcomes.
Matériel et méthodes
This retrospective single-center observational study included 156 patients undergoing elective cardiac surgery with CPB, comparing perioperative continuation (n = 68) vs. discontinuation (n = 88) of SGLT2i (≥24 hours before surgery). The primary outcome was postoperative fluid balance at Day 1, with secondary outcomes including fluid balance from Day 2 to 5, ICU length of stay, AKI incidence, and postoperative complications.
Résultats & Discussion
Postoperative fluid balance at Day 1 was comparable between groups (continuation: -636 mL [-1075; 133] vs. cessation: -470 mL [-953; 33]; p = 0.278). Similarly, ICU length of stay and postoperative complications did not differ significantly. However, ICU mortality was higher in the continuation group (6 deaths vs. none; p = 0.028) and the median fluid balance was higher at Day 2 in the continuation group : 647 mL (- 1 806 mL ; 225 mL) (p = 0,035).
Conclusion
Perioperative continuation of SGLT2i does not significantly alter fluid balance, AKI incidence, or ICU stay in patients undergoing elective cardiac surgery with CPB. However, the increased ICU mortality and the higher fluid balance in Day 2 in the continuation group raises concerns, highlighting the need for further investigation before recommending routine perioperative continuation of SGLT2i.
Auteurs
Océane VIDAL, Mohammed TANNOUCHE-BENNANI, Philippe GUERCI, Thomas KLEIN - (1)Department Of Anesthesia And Critical Care, University Hospital Of Nancy, Nancy, France, Nancy, France