Intensive versus conservative glycemic control in patients undergoing coronary artery bypass graft surgery: A protocol for systematic review of randomised controlled trials

PLOS ONE STUDY PROTOCOL Intensive versus conservative glycemic control in patients undergoing coronary artery bypass graft surgery: A protocol for systematic review of randomised controlled trials Yi Liu, Xia-xuan Sun, Wen-ya Du, Ting-ting Chen, Meng Lv ID* Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji’nan, Shandong Province, China a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 * Abstract Introduction OPEN ACCESS Citation: Liu Y, Sun X-x, Du W-y, Chen T-t, Lv M (2022) Intensive versus conservative glycemic control in patients undergoing coronary artery bypass graft surgery: A protocol for systematic review of randomised controlled trials. PLoS ONE 17(10): e0276228. https://doi.org/10.1371/journal. pone.0276228 Editor: Ozra Tabatabaei-Malazy, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, ISLAMIC REPUBLIC OF IRAN Received: July 5, 2022 Accepted: October 4, 2022 Published: October 18, 2022 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0276228 Copyright: © 2022 Liu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hyperglycemia and hypoglycemia are common during coronary artery bypass graft (CABG) and are associated with a variety of postoperative outcomes. Therefore, the strategy of intraoperative glycemic control is an important issue for the patients undergoing CABG. This systematic review aims to evaluate the effect of different intraoperative glycemic control strategies on postoperative outcomes. Methods and analyses We will perform this systematic review of randomised controlled trials (RCTs) according to the recommendations of the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA). Relevant studies will be searched in Medline, Embase, Cochrane Library and Web of Science. Two independent reviewers will conduct study selection, data extraction, risk of bias and quality assessment. The primary outcome is postoperative mortality, and the secondary outcomes include the duration of mechanical ventilation in the intensive care unit (ICU), the incidence of postoperative myocardial infarction (MI), the incidence of postoperative atrial fibrillation (AF), the type and volume of blood product transfusion, the rate of rehospitalization, the rate of cerebrovascular accident, the rate of significant postoperative bleeding, the rate of infection, the incidence of acute kidney failure (AKF), hospital and ICU lengths of stay (LOS). ReviewManager 5.4 will be used for data management and statistical analysis. The Cochrane risk-of -bias tool 2.0 and GRADEpro will be applied for risk of bias and quality assessment of the evidence. Discussion There is no consensus that which strategy of glycemic control is better for improving postoperative complications of patients undergoing CABG. The results of our study might provide some evidence for the relationship between intraoperative glycemic control strategies and postoperative outcomes in patients undergoing CABG. PLOS ONE | https://doi.org/10.1371/journal.pone.0276228 October 18, 2022 1/8 PLOS ONE Data Availability Statement: No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion. Funding: Yes. Natural Science Foundation of Shandong Province (ZR2016HL02) play roles in study design and preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Intensive versus conservative glycemic control in patients undergoing coronary artery bypass graft surgery 1. Introduction Nowadays, coronary artery bypass graft (CABG) surgery has become the most common surgical procedure. Almost 400,000 patients accept CABG annually [1]. Previous studies have shown that hyperglycemia during cardiac surgery is associated with hospital complications including mortality, renal failure, wound infections and the duration of mechanical ventilation, if it is not well controlled [2–6]. Besides, hyperglycemia has also been thought to increase perioperative morbidity and mortality [7]. On the other hand, it has been suggested that there may be a significant reduction in early mortality in patients who accepted the intensive glycemic control strategy during CABG [8– 11]. However, other evidence of severe hypoglycemia resulted from intensive glycemic control brings the safety and effectiveness of intraoperative glycemic control strategy into question [5, 7, 12]. Moreover, hypoglycemia has also been considered as an independent risk factor of undesired clinical outcomes and hospital mortality [13]. Several studies confirmed that the incidence of hypoglycemia was associated with the overall risk of hospital mortality and the increased risk of cardiovascular events in critically ill patients [5, 14–16]. However, the optimal glycemic control strategy for patients undergoing CABG surgery remains controversial. Therefore, we will perform this systematic review and meta-analysis of randomised controlled trials to investigate the different effects of conservative and intensive glycemic control strategies on postoperative short-term mortality and severe complications in patients undergoing CABG. 2. Methods and analyses 2.1 Protocol design and registration Our study has been registered at PROSPERO international prospective register of systematic reviews (https://www.crd.york.ac.uk/PROSPERO/). The registration number is CRD42021240841. The protocol is performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) 2015 checklist [17]. The PRISMA-P 2015 checklist will be shown in S1 Checklist. We will conduct our systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 statement [18]. 2.2 Inclusion and exclusion criteria 2.2.1 Study design. Randomised controlled trials (RCTs) will be strictly screened. Crossover studies and quasi-randomised controlled trials will be excluded. 2.2.2 Population. Studies including patients undergoing CABG surgery who have accepted intraoperative glycemic control will be included. Studies including patients with incomplete information will be excluded. 2.2.3 Intervention and comparator groups. Studies with at least two glycemic control groups (intensive group and conservative group) will be included. In the systematic review, the group with a lower blood g (...truncated)