A novel glyco-inflammatory healing index for risk prediction after isolated coronary artery bypass grafting: a multicenter retrospective cohort study
5 affiliations
- 1Heart Center, Kaplan Medical Center, Affiliated with the Hebrew University
- 2Palestinian Clinical Research Center
- 3Gray Faculty of Medical & Health Sciences, Tel Aviv University
- 4Department of Internal Medicine A, Kaplan Medical Center, Faculty of Medicine, Hebrew University of Jerusalem
- 5Department of Diabetes, Endocrinology and Metabolism, Gray Faculty of Medical and Health Sciences, Wolfson Medical Center, Tel Aviv University
Abstract
Background The Glyco-Inflammatory Healing Index (GIHI), calculated as HbA1c × C-reactive protein / albumin, integrates measures of glycemic control, systemic inflammation, and nutritional status. Its association with postoperative outcomes after isolated coronary artery bypass grafting (CABG) has not been fully established, particularly according to diabetes status. Methods We conducted a retrospective, international, multicenter cohort study of 6,262 adults who underwent isolated CABG between 2010 and 2025. Patients were stratified by diabetes status. GIHI was analyzed as a standardized continuous variable and descriptively categorized as high or low based on subgroup medians. The primary outcome was 30-day major adverse cardiovascular events (MACE), defined as all-cause mortality, myocardial infarction, stroke, or repeat revascularization. The secondary outcome was long-term all-cause mortality. Associations were evaluated using Cox regression, Kaplan-Meier analysis, restricted cubic splines, subgroup analyses, and receiver operating characteristic curves. Results Among 6,262 patients, 2,783 (44.5%) had diabetes. In diabetic patients, higher GIHI was associated with 30-day MACE (adjusted hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.28–1.65), 30-day myocardial infarction (HR 1.27, 95% CI 1.00-1.60), 30-day mortality (HR 2.56, 95% CI 2.06–3.18), and long-term mortality (HR 2.57, 95% CI 2.33–2.83). In non-diabetic patients, GIHI was not associated with 30-day MACE but remained associated with 30-day and long-term mortality. Adding GIHI modestly improved discrimination for 30-day MACE in diabetic patients (AUC 0.65 to 0.69; p < 0.001). Conclusions Higher GIHI was associated with adverse postoperative outcomes after isolated CABG, particularly in patients with diabetes. These findings suggest GIHI may provide incremental prognostic information, but prospective validation is needed before its routine clinical application. Graphical abstract
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BibTeX
@article{khadija2026novel,
title = {{A novel glyco-inflammatory healing index for risk prediction after isolated coronary artery bypass grafting: a multicenter retrospective cohort study}},
author = {Haitham Abu Khadija and Mohammad Alnees and Enrique Z. Fisman and Kareem Ibraheem and Sergey Amunts and Duha Najajra and Alena Kirzhner and Ehud Raanani and Tal Schiller and Mohammad Masu’d and Nizar Abu Hamdeh and Yahya Z. Fraitekh and Alexander Kogan and Leonid Sternik},
journal = {Cardiovascular Diabetology},
year = {2026},
month = aug,
doi = {10.1186/s12933-026-03322-w},
url = {https://doi.org/10.1186/s12933-026-03322-w},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - A novel glyco-inflammatory healing index for risk prediction after isolated coronary artery bypass grafting: a multicenter retrospective cohort study
AU - Haitham Abu Khadija
AU - Mohammad Alnees
AU - Enrique Z. Fisman
AU - Kareem Ibraheem
AU - Sergey Amunts
AU - Duha Najajra
AU - Alena Kirzhner
AU - Ehud Raanani
AU - Tal Schiller
AU - Mohammad Masu’d
AU - Nizar Abu Hamdeh
AU - Yahya Z. Fraitekh
AU - Alexander Kogan
AU - Leonid Sternik
PY - 2026
DA - 2026/08/01
JO - Cardiovascular Diabetology
DO - 10.1186/s12933-026-03322-w
UR - https://doi.org/10.1186/s12933-026-03322-w
AB - Background The Glyco-Inflammatory Healing Index (GIHI), calculated as HbA1c × C-reactive protein / albumin, integrates measures of glycemic control, systemic inflammation, and nutritional status. Its association with postoperative outcomes after isolated coronary artery bypass grafting (CABG) has not been fully established, particularly according to diabetes status. Methods We conducted a retrospective, international, multicenter cohort study of 6,262 adults who underwent isolated CABG between 2010 and 2025. Patients were stratified by diabetes status. GIHI was analyzed as a standardized continuous variable and descriptively categorized as high or low based on subgroup medians. The primary outcome was 30-day major adverse cardiovascular events (MACE), defined as all-cause mortality, myocardial infarction, stroke, or repeat revascularization. The secondary outcome was long-term all-cause mortality. Associations were evaluated using Cox regression, Kaplan-Meier analysis, restricted cubic splines, subgroup analyses, and receiver operating characteristic curves. Results Among 6,262 patients, 2,783 (44.5%) had diabetes. In diabetic patients, higher GIHI was associated with 30-day MACE (adjusted hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.28–1.65), 30-day myocardial infarction (HR 1.27, 95% CI 1.00-1.60), 30-day mortality (HR 2.56, 95% CI 2.06–3.18), and long-term mortality (HR 2.57, 95% CI 2.33–2.83). In non-diabetic patients, GIHI was not associated with 30-day MACE but remained associated with 30-day and long-term mortality. Adding GIHI modestly improved discrimination for 30-day MACE in diabetic patients (AUC 0.65 to 0.69; p < 0.001). Conclusions Higher GIHI was associated with adverse postoperative outcomes after isolated CABG, particularly in patients with diabetes. These findings suggest GIHI may provide incremental prognostic information, but prospective validation is needed before its routine clinical application. Graphical abstract
SN - 1475-2840
ER -