Does preoperative homocysteine level influence the postoperative period in diabetic or non-diabetic patients undergoing coronary artery bypass grafting?

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Anna Marcinkiewicz, Aleksandra Ryk, Wojciech Wiese, Michał Krejca, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8709727/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Background: Elevated homocysteine (Hcy) has been linked to endothelial dysfunction and adverse cardiovascular outcomes. However, its specific role in patients with type 2 diabetes mellitus (T2DM) undergoing coronary artery bypass grafting (CABG) is not well established. Methods: We conducted a prospective analysis of 66 patients (27 with T2DM, 39 controls) who underwent elective CABG. Clinical, biochemical, and postoperative data were collected for all participants. Spearman’s correlation assessed associations between Hcy and laboratory parameters, while univariable and multivariable logistic regression examined relationships with complications. Results: Preoperative median Hcy levels were similar in T2DM patients and controls (12.6 vs. 12.1 µmol/L, p = 0.24). In the total cohort, Hcy showed positive correlations with triglycerides (r = 0.39, p = 0.0018), C-peptide (r = 0.33, p = 0.0086), and CRP (r = 0.29, p = 0.0210), and a negative correlation with HDL cholesterol (r = –0.31, p = 0.0149). Higher Hcy levels were significantly associated with acute kidney injury (AKI) or exacerbation of chronic kidney disease (CKD) after CABG (b = 7.14, SE = 2.11, b⁎ = 0.40, p = 0.0013). Conclusion: Elevated preoperative Hcy levels were associated with postoperative renal complications after CABG. Therefore, Hcy may serve as a potential biomarker of AKI or exacerbation of CKD after CABG. homocysteine coronary artery bypass grafting diabetes mellitus acute kidney injury Figures Figure 1 Figure 2 Figure 3 WHAT’S NEW? This prospective study shows that preoperative homocysteine levels are associated with the occurrence of acute kidney injury or exacerbation of chronic kidney disease after coronary artery bypass grafting, regardless of diabetes status. Importantly, this association was observed even at homocysteine concentrations below the conventional threshold for hyperhomocysteinemia. These findings suggest that homocysteine may serve as a biomarker of cardiorenal vulnerability in patients undergoing cardiac surgery. Introduction Coronary artery disease (CAD) remains a leading health problem worldwide. Despite progress in medical and interventional therapies, outcomes remain unsatisfactory [1]. For patients with multivessel or advanced disease, coronary artery bypass grafting (CABG) is often the preferred revascularization method. This is especially true for high-risk populations such as those with type 2 diabetes mellitus (T2DM) [2]. T2DM is a proinflammatory state [3]. However, diabetic patients experience less favorable postoperative outcomes and a higher incidence of complications. This highlights the need to identify additional risk factors in patients with CAD and diabetes [4]. Homocysteine (Hcy), is a non-proteinogenic amino acid is derived from methionine metabolism [5]. It is a recognized factor in the development of atherosclerosis, endothelial dysfunction, and thrombosis [6,7,8]. Elevated plasma Hcy levels promote oxidative stress, inflammation, and vascular injury. These factors contribute to cardiovascular (CV) and renal complications [6,8]. Previous studies have linked hyperhomocysteinemia (HHcy) with increased CV risk and poor graft patency [9,10]. However, data on its role in the postoperative period after CABG, particularly in patients with T2DM, remain limited. Understanding the contribution of elevated Hcy to adverse outcomes, including renal dysfunction, could enhance risk stratification and improve perioperative management strategies. The aim of this study was to evaluate the relationship between Hcy levels in patients with CAD and T2DM undergoing CABG and the postoperative period. Materials and Methods Study population This study prospectively enrolled 66 patients who underwent CABG in the Central Teaching Hospital of the Medical University of Lodz, Poland. We included adult patients (age ≥ 18 years) who underwent elective isolated CABG on extracorporeal circulation. Patients with T2DM were identified based on a documented medical history of diabetes and glycated hemoglobin (HbA1c) levels obtained at each hospital admission. Non-diabetic control patients were those without any history of diabetes and with normal preoperative glycemic status. We excluded patients with type 1 diabetes, presence of anti-diabetic antibodies, end-stage renal disease on dialysis, active hepatic disease, and current or previous vitamin B12 or folate deficiency (as these conditions significantly affect Hcy metabolism). The study sample consisted of 66 patients who met the criteria, with 27 in the T2DM group and 39 in the non-diabetic control group. Clinical evaluations were performed at baseline, including assessment of age, BMI, medical history, and a comprehensive set of laboratory tests for each patient. Serum samples were collected after a 12-hour overnight fast. Clinical complications which were taken into consideration included: perioperative myocardial injury was defined as the occurrence of at least one of: significant prolonged increase of myocardial necrosis markers, low output syndrome, non-specific electrocardiogram changes, or decrease of ejection fraction (global contractility impairment) confirmed on echocardiography [11]. Infections included the full scope of wound problems, such as any problems with wound healing, as well as effusion from the wound [12]. Respiratory complications were defined as any complications related to this system, such as pleural effusion, infections, and prolonged mechanical ventilation [12]. Neurological and psychiatric complications were defined as new postoperative STS-defined cerebrovascular events or DSM-5–defined acute cognitive disturbances [13,14]. Acute kidney injury (AKI) or exacerbation of chronic kidney disease (CKD) was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria [15]. The study was approved by the Ethics Committee of the Medical University of Lodz (consent no. RNN/187/21/KE issued on 13.07.2021). Informed consent to participate in the study was obtained from each patient participating in the study. Statistical Analysis Statistical analysis was conducted using STATISTICA software (version 13.3, StatSoft, TIBCO Software Inc., Poland). Nominal variables were presented as frequencies and percentages. Continuous variables were expressed as medians with interquartile ranges. Comparisons between independent groups were performed using the Mann–Whitney U test, and statistically significant results were visualized with box-and-whisker plots. Paired observations were analyzed using the Wilcoxon signed-rank test. Correlations between variables were assessed using Spearman’s rank correlation coefficient (Spearman’s R), with significant findings illustrated by scatter plots. Logistic regression analysis was used to examine the association between homocysteine levels and the occurrence of postoperative complications. A p-value of < 0.05 was considered statistically significant. Results Characteristics of the study group The study included 66 patients undergoing CABG: 27 with T2DM and 39 controls. Men were the majority in both groups (81.5% and 84.6%). Patients with T2DM were slightly older (median 69 vs. 68 years) and had higher body mass index (29.07 vs. 27.30 kg/m², p = 0.045) and HbA1c levels (50.8 vs. 37.7 mmol/mol, p < 0.001) compared to controls. Median plasma Hcy concentrations were similar between groups (12.6 vs. 12.1 µmol/L, p = 0.24). High-density lipoprotein (HDL) cholesterol was significantly lower in T2DM patients than in controls (1.01 vs. 1.19 mmol/L, p = 0.043). Other lipid parameters, inflammatory markers (CRP, fibrinogen), and hematological indices were similar between groups. Postoperative myocardial injury markers (troponin and CKMB1) were also comparable, except for CKMB1 at 24 hours, which was lower in the T2DM group (p = 0.036). Among T2DM patients, 14 (52%) received insulin (12 via subcutaneous injection, 2 via insulin pump), 20 (74%) received metformin, and 5 (19%) were treated with an SGLT2 inhibitor (Table 2 ). Detailed study population characteristics are provided in Table 1 . Table 1 Characteristics of the study group Characteristic T2DM (N = 27) Control (N = 39) Characteristic N (%) N (%) P value Sex (Male) 22 (81.48%) 33 (84.62%) 0.7369 Me (25–75%) Me (25–75%) Age 69.00 (66.00–73.00) 68.00 (60.00–71.00) 0.0516 BMI [kg/m2] 29.07 (27.55–31.43) 27.30 (24.74–30.49) 0.0451 C-peptide [nmol/L] 1.10 (0.81–1.69) 1.52 (1.02–2.33) 0.0631 HbA1c [mmol/mol] 50.82 (45.36–61.75) 37.71 (36.62–39.89) < 0.0001 Hcy [umol/L] 12.60 (11.20–17.00) 12.05 (9.30-17.25) 0.2420 HCT [%] 40.50 (37.40–42.30) 40.70 (36.30–43.20) 1.0000 HGB [g/dL] 13.80 (12.80–14.60) 13.80 (12.70–14.70) 0.7148 WBC [*10`3/uL] 9.15 (7.03–9.62) 7.86 (6.58-9.00) 0.1337 PLT [*10`3/uL] 254.00 (195.00-272.00) 216.00 (188.00-251.00) 0.1353 CRP [mg/L] 2.10 (1.10–4.80) 3.50 (1.10–8.70) 0.2731 Triglicerides [mmol/L] 1.49 (1.07–2.34) 1.40 (1.20–2.05) 0.4559 Total cholesterol [mmol/L] 3.99 (3.07–4.30) 4.16 (3.53–5.07) 0.1116 LDL [mmol/L] 2.25 (1.84–2.65) 2.75 (2.03–3.48) 0.1176 HDL [mmol/L] 1.01 (0.91–1.21) 1.19 (0.96–1.49) 0.0432 Troponin before CABG [ng/L] 441.00 (217.00-790.00) 604.00 (377.00-932.00) 0.1729 Troponin 24 h post-surgery [ng/L] 468.00 (329.00–1 356.00) 757.00 (375.00–1 033.00) 0.4076 CKMB1 before surgery [ng/mL] 21.00 (16.00-27.70) 25.80 (20.00-36.80) 0.0990 CKMB1 after 24 hours [ng/mL] 18.80 (13.80–27.90) 27.40 (18.00–54.00) 0.0363 CRP post-surgery [mg/l] 197.40 (139.35–254.30) 208.20 (176.50-261.20) 0.2997 Fibrynogen 24 hours after CABG [mg/dL] 214.50 (169.00-301.00) 209.00 (177.00-309.00) 0.8513 Data are presented as median (interquartile range). P < 0.05 was considered statistically significant. BMI (Body Mass Index); HbA1c (Glycated Hemoglobin), Hcy (Homocysteine; HCT (Hematocrit) HGB (Hemoglobin); WBC (White Blood Cell); PLT (Platelet) ; CRP (C-Reactive Protein); LDL (Low-Density Lipoprotein); HDL (High-Density Lipoprotein); CKMB (Creatine Kinase Myocardial Band) *U Mann-Whitney test Table 2 Summary of treatments used for patients with T2DM. T2DM (N = 27) Diabetes Treatment N (%) Insulin therapy 14 (51.85%) Subcutaneous insulin injections 12 (44.44%) Insulin pump 2 (7.41%) Metformin 20 (74.07%) SGLT2 inhibitors 5 (18.52%) Hcy associations with clinical and laboratory parameters Spearman correlation analysis assessed associations between Hcy levels and selected clinical and biochemical parameters in patients with T2DM, controls, and the total study population (Table 3 ). In the T2DM group, Hcy showed significant positive correlations with CRP (r = 0.42, p = 0.0331) and Troponin measured before CABG (r = 0.40, p = 0.0438), and non-significant negative correlation with HDL (r=-0.35, p = 0.0831). In controls, Hcy was significantly positively correlated with Triglycerides (r = 0.57, p < 0.001), C-peptide (r = 0.52, p = 0.0011), and Fibrinogen measured 24 hours after CABG (r = 0.34, p = 0.0433). In the overall cohort, serum Hcy levels were significantly positively correlated with Triglycerides (r = 0.39, p = 0.0018), C-peptide (r = 0.33, p = 0.0086), and CRP (r = 0.29, p = 0.021), and significantly negatively correlated with HDL (r=-0.31, p = 0.015). Table 3 The results of Spearman correlation between the serum homocystein level [ umol/l] and the clinical and laboratory parameters. T2DM (N = 27) Control (N = 39) Total (N = 66) Characteristic N Spearman R P value N Spearman R P value N Spearman R P value Age 26 0.21 0.3144 36 0.22 0.1957 62 0.25 0.0527 BMI [kg/m2] 26 0.05 0.7919 35 0.00 0.9802 61 0.04 0.7878 Triglicerides [mmol/l] 26 0.12 0.5738 35 0.57 0.0003 61 0.39 0.0018 Total cholesterol [mmol/l] 26 0.02 0.9089 36 0.08 0.6615 62 -0.01 0.9285 LDL [mmol/l] 26 0.09 0.6694 36 0.27 0.1094 62 0.14 0.2703 HDL [mmol/l] 26 -0.35 0.0831 36 -0.23 0.1798 62 -0.31 0.0149 C-peptide [nmol/l] 26 0.23 0.2580 36 0.52 0.0011 62 0.33 0.0086 HbA1c [mmol/mol] 26 0.21 0.3101 36 -0.18 0.3031 62 0.06 0.6250 CRP [mg/l] 26 0.42 0.0331 36 0.27 0.1159 62 0.29 0.0210 CRP 24 hours after CABG [mg/l] 23 0.14 0.5379 27 0.20 0.3132 50 0.12 0.3960 Troponin before CABG [ng/L] 26 0.40 0.0438 36 0.14 0.4313 62 0.23 0.0752 Troponin 24 hours after CABG [ng/L] 26 0.18 0.3792 36 0.05 0.7501 62 0.11 0.4116 CKMB1 before CABG [ng/mL] 26 0.11 0.6050 36 -0.05 0.7878 62 -0.03 0.8061 CKMB1 24 hours after CABG [ng/mL] 26 0.01 0.9438 36 0.05 0.7626 62 -0.06 0.6620 Fibrynogen 24 hours after CABG [mg/dL] 25 -0.14 0.4901 36 0.34 0.0433 61 0.17 0.1892 Table 4 Comparison of laboratory parameters between patients with and without acute kidney injury or exacerbation of chronic kidney disease. Acute kidney injury or exacerbation of chronic kidney disease Complications (Yes) N = 12 Complications (No) N = 54 Characteristic Median (25–75%) Median (25–75%) P value Hcy [umol/l] (N = 62) 19.87 (10.05–26.75) 12.05 (10.60–15.90) 0.0777 CRP [mg/l] (N = 66) 4.30 (1.40–6.40) 2.70 (1.00-6.40) 0.2616 CRP [mg/l] after 24 hours (N = 52) 255.75 (198.70-275.70) 197.40 (168.25–248.60) 0.0574 Troponin [ng/L] (N = 66) 785.00 (536.50-1 502.50) 494.50 (295.00-839.00) 0.0614 Troponin 24 hours after CABG [ng/L](N = 66) 1 557.50 (770.50-2 292.50) 483.00 (369.00-955.00) 0.0011 CKMB1 [ng/mL] (N = 66) 25.80 (20.30–35.80) 23.45 (18.80–34.40) 0.5114 CKMB1 after 24 hours [ng/mL] (N = 66) 37.85 (20.20-84.15) 21.65 (14.60–44.60) 0.0739 Fibrinogen [mg/dL] (N = 65) 242.50 (180.00-411.50) 209.00 (171.00-296.00) 0.4026 The most common complication was atrial fibrillation, observed in 28.8% of all patients, with a similar frequency in the T2DM group and the control group (25.9% vs. 30.8%, p = 0.785). In T2DM group, perioperative myocardial injury, infections, and acute kidney injury or exacerbation of chronic kidney disease were the most prevalent complications. Respiratory system complications occurred in 21.2% of patients (18.5% in T2DM, 23.1% in control, p = 0.7647), while neurological or psychiatric complications were noted in 13.6% (11.1% in T2DM, 15.4% in control, p = 0.727) Infectious complications tended to be more frequent among patients with T2DM compared to controls (25.9% vs. 7.7%, p = 0.0773). Perioperative myocardial injury was observed in 6.1% of the total group, mostly in patients with T2DM (11.1% vs. 2.5% in controls, p = NA). Acute kidney injury or exacerbation of CKD occurred in 18.2% of patients, being more frequent in the T2DM subgroup (25.9% vs. 12.8%, p = 0.2063). Two deaths were recorded in total (3.0%), one in each group. Table 5 summarizes the occurrence of complications. No statistically significant differences in complication rates were observed between the groups. Table 5 Summary of the occurence of complications in total group of patients, patients with T2DM and the control group. Total (N = 66) T2DM (N = 27) Control (N = 39) Complications N (%) N (%) N (%) P value* Respiratory system complications 14 (21.21%) 5 (18.52%) 9 (23.08%) 0.7647 Neurological or psychiatric 9 (13.64%) 3 (11.11%) 6 (15.38%) 0.7270 Infections 10 (15.15%) 7 (25.93%) 3 (7.69%) 0.0773 Myocardial infarction 4 (6.06%) 3 (11.11%) 1 (2.46%) NA Atrial fibrillation 19 (28.79%) 7 (25.93%) 12 (30.77%) 0.7850 Acute kidney injury or exacerbation of chronic kidney disease 12 (18.18%) 7 (25.93%) 5 (12.82%) 0.2063 Death 2 (3.03%) 1 (3.70%) 1 (2.56%) NA Univariable logistic regression analysis demonstrated a significant positive association between Hcy levels and acute kidney injury or exacerbation of chronic kidney disease (OR [95% CI] = 1.15 [1.03–1.27], p = 0.0099) (Table 6 ). There were no significant links between Hcy and respiratory, neurological, psychiatric, infectious, or atrial fibrillation complications (p > 0.05). Table 6 Association between the level of homocystein and complications following CABG – univariate logistic regression models. Type of post-operative complications OR (95%CI) P value Acute kidney injury or exacerbation of chronic kidney disease (yes) 1.15 (1.03–1.27) 0.0099 Atrial fibrillation (yes) 1.02 (0.95–1.10) 0.5551 Infections (yes) 1.02 (0.93–1.11) 0.7015 Neurological or psychiatric complications (yes) 1.07 (0.98–1.16) 0.1502 Respiratory system complications (yes) 0.98 (0.89–1.08) 0.6662 We decided to assess correlation between postoperative complications and Hcy level in total study population because prevalence of complication was too low in particular groups. After adjustment for postoperative CRP, homocysteine remained independently associated with acute kidney injury or exacerbation of chronic kidney disease after CABG (OR [95% CI] = 1.15 [1.03–1.27], p = 0.0099), while postoperative CRP was not independently associated with the outcome (Table 7 ). Table 7 Association of homocysteine and postoperative CRP with acute kidney injury after CABG – multivariate logistic regression model. OR (95% CI) P value Homocystein [umol/l] 1.13 (1.01–1.26) 0.0314 CRP [mg/l] post-operative 1.01 (1.00-1.02) 0.1378 Discussion Our findings confirmed that the association between Hcy levels and AKI or exacerbation of CKD occurs in both diabetic and non-diabetic patients undergoing surgical revascularization. These findings are consistent with previous research [16]. Other studies indicate that HHcy may exacerbate renal function through mitochondrial damage [17,18], oxidative stress, endothelial dysfunction, and microvascular injury [6,19] We did not divide subgroups by HHcy severity, as neither the study nor the control group exhibited HHcy (HHcy was defined as total Hcy concentrations > 15 µmol/L [20]). Nevertheless, we observed a positive correlation between plasma Hcy levels and the incidence of AKI or exacerbation of CKD, suggesting that even modest elevations in Hcy may reflect subclinical metabolic or endothelial vulnerability. However, if we analyzed the level of Hcy in patients with renal complications, this group had higher plasma Hcy level (19,87 vs 12,06, see Table 4 ) Statistical significance was not reached, probably due to small number of enrolled patients (12 with AKI or exacerbation of CKD) Zheng-Rong Li et al. also confirmed relation between higher levels of Hcy and AKI after cardiac surgery [21]. Other established risk factors for AKI include diabetes, aging, and heart failure [22]. In our cohort, we observed no difference in T2DM prevalence or age between those with and without AKI or exacerbation of CKD, and the age difference was not statistically significant. We also did not observe any association between HHcy and heart failure in either group. In addition, patients with HHcy exhibit increased inflammatory activity [23]. Inflammation is a well-established contributor to the development and progression of atherosclerosis. This provides a mechanistic link between metabolic disturbances and vascular injury [24,25]. HHcy also increases the risk of atherosclerosis, especially in individuals with end-stage renal failure [26]. Atherosclerosis can then promote further inflammation in the vascular wall. This creates a cycle in which HHcy, inflammation, and vascular injury fuel each other [25]. Jane Durga et al. in a double-blind, randomized, placebo-controlled trial showed that lowering slightly elevated Hcy concentrations, by 1-year folic acid supplementation, doesn't change the inflamatory state [27]. Elevated Hcy levels may serve as an additional biomarker of renal vulnerability to damage after CABG. This is clinically important because AKI significantly increases in-hospital mortality and may lead to CKD [28,29]. In addition, folic acid supplementation lowers Hcy levels, suggesting that Hcy may be a modifiable risk factor [27,30,31]. Furthermore, in animal models, folic acid supplementation improved renal parameters during AKI [32]. Conversely, administration of high doses of folic acid is a method to induce acute kidney injury, a condition widely recognized as folic acid–induced nephropathy [33,34]. Conditions such as vitamin cofactor deficiency, enzyme deficiency (including MTHFR variants), or increased methionine intake are known causes of HHcy. [35,36]. It remains unclear to what extent Hcy levels are modifiable and how supplying Hcy-lowering substances (such as folic acid and vitamin B12) before and after surgery affects the incidence of AKI. Therefore, it is important to conduct further studies with the administration of folic acid and/or vitamin cofactors or their methylated forms (5-MTHF, methylocobalamin). Emphasis should also be put on the genetical background of HHcy. Polymorphism of MTHFR gen is connected with HHcy. Waśkiewicz et al. showed that only T/T genotype is associated with increased level and cardiovascular risk (CV). Interestingly that study showed also high prevalence of folate deficiency in Polish population [37]. Results of some studies suggest that lowering Hcy level by supplementing folic acid doesn’t change CV [36,38]. The results suggest that Hcy may be only a symptom and does not necessarily contribute to an increased risk of AKI or cardiovascular disease, as does inflammation. Our study has several limitations. First, the cohort was relatively small and derived from a single center. Larger, multicenter studies are needed to confirm our observations. Second, we did not measure folate or vitamin B12 levels, which are important cofactors influencing Hcy metabolism. Third, long-term outcomes and post-discharge kidney function were not assessed. Conclusion Hcy was significantly associated with AKI or exacerbation of CKD after CABG. Patients with AKI or exacerbation of CKD had higher Hcy levels (p < 0.01). We suggest that higher preoperative Hcy levels may influence the prevalence of AKI or exacerbation of CKD independently of inflammatory status. Univariable regression showed that Hcy predicted AKI or exacerbation of CKD (odds ratio per µmol/L > 4, p < 0.01). Hcy also correlated with adverse metabolic and inflammatory profiles: higher triglycerides, CRP, and C-peptide, and lower HDL cholesterol. However, no association between Hcy and heart failure was observed. Abbreviations AKI — Acute kidney injury BMI — Body mass index CABG — Coronary artery bypass grafting CAD — Coronary artery disease CKD — Chronic kidney disease CKMB — Creatine kinase myocardial band CRP — C-reactive protein CV — Cardiovascular HbA1c — Glycated hemoglobin Hcy — Homocysteine HCT — Hematocrit HDL — High-density lipoprotein HHcy — Hyperhomocysteinemia HGB — Hemoglobin KDIGO — Kidney Disease: Improving Global Outcomes LDL — Low-density lipoprotein PLT — Platelet count STS — Society of Thoracic Surgeons T2DM — Type 2 diabetes mellitus WBC — White blood cell Declarations Data availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Acknowledgements The authors wish to thank the participants of the study for their generous contributions. Funding None. Author information Department of Cardiac Surgery, Medical University of Lodz, Lodz, Poland Anna Marcinkiewicz, Wojciech Wiese, Michał Krejca Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland Aleksandra Ryk, Wojciech Fendler Department of Clinical Chemistry and Biochemistry, Medical University of Lodz, Lodz, Poland Wojciech Wiese Contributions A.M. conceived the study concept, coordinated patient recruitment, contributed to data acquisition, and drafted the initial version of the manuscript. A.R. performed statistical analyses and participated in data interpretation. W.W. visualized, formatted and edited the manuscript, and participated in data interpretation. M.K. contributed to patient recruitment, clinical data collection, and interpretation of surgical outcomes. W.F. supervised the statistical methodology, contributed to data interpretation, and critically revised the manuscript. All authors edited and approved the final version of the manuscript. All authors contributed to the study design, reviewed and approved the final version of the manuscript, and agree to be accountable for all aspects of the work. Corresponding author Anna Marcinkiewicz, MD, Department of Cardiac Surgery, Medical University of Lodz, ul. Pomorska 251, Lodz, Poland, phone: +48 42 201 44 60 email: [email protected] Ethics declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki, and approved by the Bioethics Committee of the Medical University of Lodz, Poland (consent no. RNN/187/21/KE issued on 13.07.2021). Written informed consent was obtained from all participants involved in the study.ARTICLE IN PRESS Consent for publication Not applicable Competing interests The authors declare that they have no competing interests. References Dalén M, Ivert T, Holzmann MJ, Sartipy U. 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Heart failure is the strongest predictor of acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Kardiol Pol. 2016; 74: 18-24. Zhang S, Lv Y, Luo X, et al. Homocysteine promotes atherosclerosis through macrophage pyroptosis via endoplasmic reticulum stress and calcium disorder. Mol Med. 2023; 29: 73. Strijdhorst A, Vos WG, Bosmans LA, et al. Accelerated atherosclerosis associated with immune checkpoint inhibitors: a systematic review and meta-analysis of pre-clinical studies. Atherosclerosis. 2025; 405: 119219. Ajoolabady A, Pratico D, Lin L, et al. Inflammation in atherosclerosis: pathophysiology and mechanisms. Cell Death Dis. 2024; 15: 817. Robinson K, Gupta A, Dennis V, et al. Hyperhomocysteinemia Confers an Independent Increased Risk of Atherosclerosis in End-Stage Renal Disease and Is Closely Linked to Plasma Folate and Pyridoxine Concentrations. Circulation. 1996; 94: 2743-2748. Durga J, van Tits LJH, Schouten EG, et al. Effect of lowering of homocysteine levels on inflammatory markers: a randomized controlled trial. Arch Intern Med. 2005; 165: 1388-1394. Palomba H, Castro I, Yu L, Burdmann EA. The duration of acute kidney injury after cardiac surgery increases the risk of long-term chronic kidney disease. J Nephrol. 2017; 30: 567-572. Hoste EAJ, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015; 41: 1411-1423. González-Lamuño D, Arrieta-Blanco FJ, Fuentes ED, et al. Hyperhomocysteinemia in Adult Patients: A Treatable Metabolic Condition. Nutrients. 2023; 16: 135. Deminice R, Padilha C de S, Borges F, et al. Resistance exercise prevents impaired homocysteine metabolism and hepatic redox capacity in Walker-256 tumor-bearing male Wistar rats. Nutrition. 2016; 32: 1153-1158. Wijerathne CUB, Au-Yeung KKW, Siow YL, O K. 5-Methyltetrahydrofolate Attenuates Oxidative Stress and Improves Kidney Function in Acute Kidney Injury through Activation of Nrf2 and Antioxidant Defense. Antioxidants. 2022; 11: 1046. Katerelos M, Ratnayake C, Gleich K, et al. Obesity Augments Necroinflammation and Worsens Injury With Folic Acid-Induced Acute Kidney Injury. FASEB J. 2025; 39: e71288. Battaglia-Vieni A, Marchant V, Tejedor-Santamaria L, et al. Dasatinib and Quercetin Combination Increased Kidney Damage in Acute Folic Acid-Induced Experimental Nephropathy. Pharmaceuticals. 2025; 18: 822. Glowacki R, Jakubowski H. Cross-talk between Cys34 and lysine residues in human serum albumin revealed by N-homocysteinylation. J Biol Chem. 2004; 279: 10864-10871. Undas A, Stepień E, Glowacki R, et al. Folic acid administration and antibodies against homocysteinylated proteins in subjects with hyperhomocysteinemia. Thromb Haemost. 2006; 96: 342-347. Waśkiewicz A, Piotrowski W, Broda G, et al. Impact of MTHFR C677T gene polymorphism and vitamins intake on homocysteine concentration in the Polish adult population. Kardiol Pol. 2011; 69: 1259-1264. Jardine MJ, Kang A, Zoungas S, et al. The effect of folic acid based homocysteine lowering on cardiovascular events in people with kidney disease: systematic review and meta-analysis. BMJ. 2012; 344: e3533. Additional Declarations No competing interests reported. Supplementary Files floatimage1.jpeg Graphical Abstract Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 04 Mar, 2026 Reviews received at journal 02 Mar, 2026 Reviews received at journal 02 Mar, 2026 Reviewers agreed at journal 18 Feb, 2026 Reviewers agreed at journal 16 Feb, 2026 Reviews received at journal 16 Feb, 2026 Reviews received at journal 13 Feb, 2026 Reviews received at journal 12 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers agreed at journal 07 Feb, 2026 Reviewers agreed at journal 05 Feb, 2026 Reviewers invited by journal 05 Feb, 2026 Editor invited by journal 28 Jan, 2026 Editor assigned by journal 28 Jan, 2026 Submission checks completed at journal 28 Jan, 2026 First submitted to journal 27 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8709727","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":587500968,"identity":"2795a7d0-94b0-4340-99be-357e00c62653","order_by":0,"name":"Anna Marcinkiewicz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABLElEQVRIie3RPUvDQBjA8TsC5/LYrKeR+hWeEpBKRL/KhYJdLii4FCwYEOJUugp+DOHoGDmIS3QO1MEuzu0inapn4pYQdBO5fyDcBX7cSwix2f50jnkEIWBGaTntEIJm0P8JYaKcsorw9nWqAFuJezd5WFJ5fObebGt8Hek9d5q/7xajgLCt6/slndUIf3kecKoGh7e6MxAi18DTJ+XJfEgYZOdI8/rGComGOIgO+GmYzAHpRHlRognjEgVNamS/kP6aqqtvsjHEgTcv2lQkbSBYyAOzii6JCGNDGDAvikvSixtIz5B+qB6Ra/BRZB/Ac+YHMhuCOcsFCetn6ZqNFSt1ieai/J31+PTEnerFXI6Drvt1Y6vZUeMPEU0foXyHcaNoi/6e2Gw227/rE/9/YZeCbOnSAAAAAElFTkSuQmCC","orcid":"","institution":"Medical University of Lodz","correspondingAuthor":true,"prefix":"","firstName":"Anna","middleName":"","lastName":"Marcinkiewicz","suffix":""},{"id":587500969,"identity":"8c2ed5b0-cf62-401b-868a-ffb5a3a65856","order_by":1,"name":"Aleksandra Ryk","email":"","orcid":"","institution":"Medical University of Lodz","correspondingAuthor":false,"prefix":"","firstName":"Aleksandra","middleName":"","lastName":"Ryk","suffix":""},{"id":587500971,"identity":"5b4589dd-f8b8-45a4-94a4-4166f1b39c87","order_by":2,"name":"Wojciech Wiese","email":"","orcid":"","institution":"Medical University of Lodz","correspondingAuthor":false,"prefix":"","firstName":"Wojciech","middleName":"","lastName":"Wiese","suffix":""},{"id":587500973,"identity":"21046b6e-9e95-4410-b3ff-a6e24f3b8243","order_by":3,"name":"Michał Krejca","email":"","orcid":"","institution":"Medical University of Lodz","correspondingAuthor":false,"prefix":"","firstName":"Michał","middleName":"","lastName":"Krejca","suffix":""},{"id":587500975,"identity":"b81ce47b-f368-45d7-8b93-88307bd0c7dd","order_by":4,"name":"Wojciech Wiese","email":"","orcid":"","institution":"Medical University of Lodz","correspondingAuthor":false,"prefix":"","firstName":"Wojciech","middleName":"","lastName":"Wiese","suffix":""}],"badges":[],"createdAt":"2026-01-27 11:23:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8709727/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8709727/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102217989,"identity":"0524c089-c680-4748-b933-00b679d41b42","added_by":"auto","created_at":"2026-02-09 13:14:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":540644,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of Body Mass Index (BMI) [kg/m2] (A), High-Density Lipoprotein (HDL) [mmol/l] (B), Glycated Hemoglobin (HbA1c) [mmol/mol] (C), and Creatine Kinase Myocardial Band (CKMB1) 24 hours after Coronary Artery Bypass Grafting (CABG) between patients with T2DM and the control group.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8709727/v1/b11a9817f0b8ada618c7699f.png"},{"id":102217993,"identity":"7e45d9a6-818b-4885-b6d8-ae1524b9441a","added_by":"auto","created_at":"2026-02-09 13:14:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":488995,"visible":true,"origin":"","legend":"\u003cp\u003eThe association between serum Homocystein level [umol/l] and High-Density Lipoprotein (HDL) [mmol/l] (A), C-Reactive Protein (CRP) [mg/l] (B), Triglicerides [mmol/l] (C), C-peptide [nmol/l] (D).\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8709727/v1/8fd457cb21df3c309a005f65.png"},{"id":102217990,"identity":"0feb3e88-7f10-4f8c-9469-842dba386f9e","added_by":"auto","created_at":"2026-02-09 13:14:28","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":63059,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of troponin level 24 hours after surgery in patients with and without acute kidney injury or exacerbation of chronic kidney disease.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8709727/v1/86eefb0839414b90ec0af4e7.png"},{"id":102299209,"identity":"34911254-b35f-4d23-ad6b-b024a93f4dc7","added_by":"auto","created_at":"2026-02-10 11:03:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2038650,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8709727/v1/53fa69ff-9215-4e36-abad-dd7e8b960611.pdf"},{"id":102296858,"identity":"ed872eb0-a9f4-433c-ae62-1253a15a3392","added_by":"auto","created_at":"2026-02-10 10:22:21","extension":"jpeg","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":249188,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraphical Abstract\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8709727/v1/e23de482b8010cebc48a686d.jpeg"}],"financialInterests":"No competing interests reported.","formattedTitle":"Does preoperative homocysteine level influence the postoperative period in diabetic or non-diabetic patients undergoing coronary artery bypass grafting? ","fulltext":[{"header":"WHAT’S NEW? ","content":"\u003cp\u003eThis prospective study shows that preoperative homocysteine levels are associated with the occurrence of acute kidney injury or exacerbation of chronic kidney disease after coronary artery bypass grafting, regardless of diabetes status. Importantly, this association was observed even at homocysteine concentrations below the conventional threshold for hyperhomocysteinemia. These findings suggest that homocysteine may serve as a biomarker of cardiorenal vulnerability in patients undergoing cardiac surgery.\u003c/p\u003e\n"},{"header":"Introduction","content":"\u003cp\u003eCoronary artery disease (CAD) remains a leading health problem worldwide. Despite progress in medical and interventional therapies, outcomes remain unsatisfactory [1]. For patients with multivessel or advanced disease, coronary artery bypass grafting (CABG) is often the preferred revascularization method. This is especially true for high-risk populations such as those with type 2 diabetes mellitus (T2DM) [2]. T2DM is a proinflammatory state [3]. However, diabetic patients experience less favorable postoperative outcomes and a higher incidence of complications. This highlights the need to identify additional risk factors in patients with CAD and diabetes [4].\u003c/p\u003e \u003cp\u003eHomocysteine (Hcy), is a non-proteinogenic amino acid is derived from methionine metabolism [5]. It is a recognized factor in the development of atherosclerosis, endothelial dysfunction, and thrombosis [6,7,8]. Elevated plasma Hcy levels promote oxidative stress, inflammation, and vascular injury. These factors contribute to cardiovascular (CV) and renal complications [6,8]. Previous studies have linked hyperhomocysteinemia (HHcy) with increased CV risk and poor graft patency [9,10].\u003c/p\u003e \u003cp\u003eHowever, data on its role in the postoperative period after CABG, particularly in patients with T2DM, remain limited. Understanding the contribution of elevated Hcy to adverse outcomes, including renal dysfunction, could enhance risk stratification and improve perioperative management strategies. The aim of this study was to evaluate the relationship between Hcy levels in patients with CAD and T2DM undergoing CABG and the postoperative period.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThis study prospectively enrolled 66 patients who underwent CABG in the Central Teaching Hospital of the Medical University of Lodz, Poland. We included adult patients (age\u0026thinsp;\u0026ge;\u0026thinsp;18 years) who underwent elective isolated CABG on extracorporeal circulation. Patients with T2DM were identified based on a documented medical history of diabetes and glycated hemoglobin (HbA1c) levels obtained at each hospital admission. Non-diabetic control patients were those without any history of diabetes and with normal preoperative glycemic status. We excluded patients with type 1 diabetes, presence of anti-diabetic antibodies, end-stage renal disease on dialysis, active hepatic disease, and current or previous vitamin B12 or folate deficiency (as these conditions significantly affect Hcy metabolism). The study sample consisted of 66 patients who met the criteria, with 27 in the T2DM group and 39 in the non-diabetic control group. Clinical evaluations were performed at baseline, including assessment of age, BMI, medical history, and a comprehensive set of laboratory tests for each patient. Serum samples were collected after a 12-hour overnight fast.\u003c/p\u003e \u003cp\u003eClinical complications which were taken into consideration included: perioperative myocardial injury was defined as the occurrence of at least one of: significant prolonged increase of myocardial necrosis markers, low output syndrome, non-specific electrocardiogram changes, or decrease of ejection fraction (global contractility impairment) confirmed on echocardiography [11]. Infections included the full scope of wound problems, such as any problems with wound healing, as well as effusion from the wound [12]. Respiratory complications were defined as any complications related to this system, such as pleural effusion, infections, and prolonged mechanical ventilation [12]. Neurological and psychiatric complications were defined as new postoperative STS-defined cerebrovascular events or DSM-5\u0026ndash;defined acute cognitive disturbances [13,14]. Acute kidney injury (AKI) or exacerbation of chronic kidney disease (CKD) was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria [15].\u003c/p\u003e \u003cp\u003eThe study was approved by the Ethics Committee of the Medical University of Lodz (consent no. RNN/187/21/KE issued on 13.07.2021). Informed consent to participate in the study was obtained from each patient participating in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was conducted using STATISTICA software (version 13.3, StatSoft, TIBCO Software Inc., Poland). Nominal variables were presented as frequencies and percentages. Continuous variables were expressed as medians with interquartile ranges. Comparisons between independent groups were performed using the Mann\u0026ndash;Whitney U test, and statistically significant results were visualized with box-and-whisker plots. Paired observations were analyzed using the Wilcoxon signed-rank test. Correlations between variables were assessed using Spearman\u0026rsquo;s rank correlation coefficient (Spearman\u0026rsquo;s R), with significant findings illustrated by scatter plots. Logistic regression analysis was used to examine the association between homocysteine levels and the occurrence of postoperative complications. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the study group\u003c/h2\u003e \u003cp\u003eThe study included 66 patients undergoing CABG: 27 with T2DM and 39 controls. Men were the majority in both groups (81.5% and 84.6%). Patients with T2DM were slightly older (median 69 vs. 68 years) and had higher body mass index (29.07 vs. 27.30 kg/m\u0026sup2;, p\u0026thinsp;=\u0026thinsp;0.045) and HbA1c levels (50.8 vs. 37.7 mmol/mol, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to controls. Median plasma Hcy concentrations were similar between groups (12.6 vs. 12.1 \u0026micro;mol/L, p\u0026thinsp;=\u0026thinsp;0.24).\u003c/p\u003e \u003cp\u003eHigh-density lipoprotein (HDL) cholesterol was significantly lower in T2DM patients than in controls (1.01 vs. 1.19 mmol/L, p\u0026thinsp;=\u0026thinsp;0.043). Other lipid parameters, inflammatory markers (CRP, fibrinogen), and hematological indices were similar between groups. Postoperative myocardial injury markers (troponin and CKMB1) were also comparable, except for CKMB1 at 24 hours, which was lower in the T2DM group (p\u0026thinsp;=\u0026thinsp;0.036).\u003c/p\u003e \u003cp\u003eAmong T2DM patients, 14 (52%) received insulin (12 via subcutaneous injection, 2 via insulin pump), 20 (74%) received metformin, and 5 (19%) were treated with an SGLT2 inhibitor (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Detailed study population characteristics are provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the study group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2DM (N\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl (N\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (Male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (81.48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (84.62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMe (25\u0026ndash;75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMe (25\u0026ndash;75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69.00 (66.00\u0026ndash;73.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.00 (60.00\u0026ndash;71.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0516\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI [kg/m2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.07 (27.55\u0026ndash;31.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.30 (24.74\u0026ndash;30.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-peptide [nmol/L]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.10 (0.81\u0026ndash;1.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.52 (1.02\u0026ndash;2.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0631\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c [mmol/mol]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.82 (45.36\u0026ndash;61.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.71 (36.62\u0026ndash;39.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHcy [umol/L]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.60 (11.20\u0026ndash;17.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.05 (9.30-17.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2420\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCT [%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.50 (37.40\u0026ndash;42.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.70 (36.30\u0026ndash;43.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHGB [g/dL]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.80 (12.80\u0026ndash;14.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.80 (12.70\u0026ndash;14.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7148\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC [*10`3/uL]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.15 (7.03\u0026ndash;9.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.86 (6.58-9.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1337\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT [*10`3/uL]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e254.00\u003c/p\u003e \u003cp\u003e(195.00-272.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e216.00\u003c/p\u003e \u003cp\u003e(188.00-251.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1353\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP [mg/L]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.10 (1.10\u0026ndash;4.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.50 (1.10\u0026ndash;8.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2731\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriglicerides [mmol/L]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.49 (1.07\u0026ndash;2.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.40 (1.20\u0026ndash;2.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4559\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal cholesterol [mmol/L]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.99 (3.07\u0026ndash;4.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.16 (3.53\u0026ndash;5.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL [mmol/L]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.25 (1.84\u0026ndash;2.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.75 (2.03\u0026ndash;3.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1176\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL [mmol/L]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.01 (0.91\u0026ndash;1.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.19 (0.96\u0026ndash;1.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTroponin before CABG [ng/L]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e441.00\u003c/p\u003e \u003cp\u003e(217.00-790.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e604.00\u003c/p\u003e \u003cp\u003e(377.00-932.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1729\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTroponin 24 h post-surgery [ng/L]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e468.00\u003c/p\u003e \u003cp\u003e(329.00\u0026ndash;1 356.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e757.00\u003c/p\u003e \u003cp\u003e(375.00\u0026ndash;1 033.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKMB1 before surgery [ng/mL]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.00 (16.00-27.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.80 (20.00-36.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0990\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKMB1 after 24 hours [ng/mL]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.80 (13.80\u0026ndash;27.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.40 (18.00\u0026ndash;54.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0363\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP post-surgery [mg/l]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e197.40\u003c/p\u003e \u003cp\u003e(139.35\u0026ndash;254.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e208.20\u003c/p\u003e \u003cp\u003e(176.50-261.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2997\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFibrynogen 24 hours after CABG [mg/dL]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e214.50\u003c/p\u003e \u003cp\u003e(169.00-301.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e209.00\u003c/p\u003e \u003cp\u003e(177.00-309.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8513\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are presented as median (interquartile range). P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. BMI (Body Mass Index); HbA1c (Glycated Hemoglobin), Hcy (Homocysteine; HCT (Hematocrit) HGB (Hemoglobin); WBC (White Blood Cell); PLT (Platelet) ; CRP (C-Reactive Protein); LDL (Low-Density Lipoprotein); HDL (High-Density Lipoprotein); CKMB (Creatine Kinase Myocardial Band)\u003c/p\u003e \u003cp\u003e*U Mann-Whitney test\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of treatments used for patients with T2DM.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2DM (N\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsulin therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (51.85%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubcutaneous insulin injections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (44.44%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsulin pump\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (7.41%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetformin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (74.07%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGLT2 inhibitors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (18.52%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eHcy associations with clinical and laboratory parameters\u003c/h3\u003e\n\u003cp\u003eSpearman correlation analysis assessed associations between Hcy levels and selected clinical and biochemical parameters in patients with T2DM, controls, and the total study population (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In the T2DM group, Hcy showed significant positive correlations with CRP (r\u0026thinsp;=\u0026thinsp;0.42, p\u0026thinsp;=\u0026thinsp;0.0331) and Troponin measured before CABG (r\u0026thinsp;=\u0026thinsp;0.40, p\u0026thinsp;=\u0026thinsp;0.0438), and non-significant negative correlation with HDL (r=-0.35, p\u0026thinsp;=\u0026thinsp;0.0831). In controls, Hcy was significantly positively correlated with Triglycerides (r\u0026thinsp;=\u0026thinsp;0.57, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), C-peptide (r\u0026thinsp;=\u0026thinsp;0.52, p\u0026thinsp;=\u0026thinsp;0.0011), and Fibrinogen measured 24 hours after CABG (r\u0026thinsp;=\u0026thinsp;0.34, p\u0026thinsp;=\u0026thinsp;0.0433). In the overall cohort, serum Hcy levels were significantly positively correlated with Triglycerides (r\u0026thinsp;=\u0026thinsp;0.39, p\u0026thinsp;=\u0026thinsp;0.0018), C-peptide (r\u0026thinsp;=\u0026thinsp;0.33, p\u0026thinsp;=\u0026thinsp;0.0086), and CRP (r\u0026thinsp;=\u0026thinsp;0.29, p\u0026thinsp;=\u0026thinsp;0.021), and significantly negatively correlated with HDL (r=-0.31, p\u0026thinsp;=\u0026thinsp;0.015).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe results of Spearman correlation between the serum homocystein level [ umol/l] and the clinical and laboratory parameters.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eT2DM (N\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eControl (N\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpearman R\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSpearman R\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSpearman R\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.1957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.0527\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI [kg/m2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.9802\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.7878\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriglicerides [mmol/l]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5738\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.0018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal cholesterol [mmol/l]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.9285\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL [mmol/l]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.1094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.2703\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL [mmol/l]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0831\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.1798\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.0149\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-peptide [nmol/l]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.0086\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c [mmol/mol]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.3031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.6250\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP [mg/l]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0331\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.1159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.0210\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP 24 hours after CABG [mg/l]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.3132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.3960\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTroponin before CABG [ng/L]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.4313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.0752\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTroponin\u003c/p\u003e \u003cp\u003e24 hours after CABG [ng/L]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.7501\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.4116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKMB1\u003c/p\u003e \u003cp\u003ebefore CABG [ng/mL]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.7878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.8061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKMB1\u003c/p\u003e \u003cp\u003e24 hours after CABG [ng/mL]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.7626\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.6620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFibrynogen\u003c/p\u003e \u003cp\u003e24 hours after CABG [mg/dL]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4901\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0433\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.1892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of laboratory parameters between patients with and without acute kidney injury or exacerbation of chronic kidney disease.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute kidney injury or exacerbation of chronic kidney disease\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComplications (Yes)\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;12\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eComplications (No)\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;54\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (25\u0026ndash;75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian (25\u0026ndash;75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHcy [umol/l] (N\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.87 (10.05\u0026ndash;26.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.05 (10.60\u0026ndash;15.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0.0777\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP [mg/l] (N\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.30 (1.40\u0026ndash;6.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.70 (1.00-6.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2616\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP [mg/l] after 24 hours (N\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e255.75\u003c/p\u003e \u003cp\u003e(198.70-275.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e197.40\u003c/p\u003e \u003cp\u003e(168.25\u0026ndash;248.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0.0574\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTroponin [ng/L] (N\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e785.00\u003c/p\u003e \u003cp\u003e(536.50-1 502.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e494.50\u003c/p\u003e \u003cp\u003e(295.00-839.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0.0614\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTroponin 24 hours after CABG [ng/L](N\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 557.50\u003c/p\u003e \u003cp\u003e(770.50-2 292.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e483.00\u003c/p\u003e \u003cp\u003e(369.00-955.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKMB1 [ng/mL] (N\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.80 (20.30\u0026ndash;35.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.45 (18.80\u0026ndash;34.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKMB1 after 24 hours [ng/mL] (N\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.85 (20.20-84.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.65 (14.60\u0026ndash;44.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0.0739\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFibrinogen [mg/dL] (N\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e242.50\u003c/p\u003e \u003cp\u003e(180.00-411.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e209.00\u003c/p\u003e \u003cp\u003e(171.00-296.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe most common complication was atrial fibrillation, observed in 28.8% of all patients, with a similar frequency in the T2DM group and the control group (25.9% vs. 30.8%, p\u0026thinsp;=\u0026thinsp;0.785). In T2DM group, perioperative myocardial injury, infections, and acute kidney injury or exacerbation of chronic kidney disease were the most prevalent complications. Respiratory system complications occurred in 21.2% of patients (18.5% in T2DM, 23.1% in control, p\u0026thinsp;=\u0026thinsp;0.7647), while neurological or psychiatric complications were noted in 13.6% (11.1% in T2DM, 15.4% in control, p\u0026thinsp;=\u0026thinsp;0.727) Infectious complications tended to be more frequent among patients with T2DM compared to controls (25.9% vs. 7.7%, p\u0026thinsp;=\u0026thinsp;0.0773). Perioperative myocardial injury was observed in 6.1% of the total group, mostly in patients with T2DM (11.1% vs. 2.5% in controls, p\u0026thinsp;=\u0026thinsp;NA). Acute kidney injury or exacerbation of CKD occurred in 18.2% of patients, being more frequent in the T2DM subgroup (25.9% vs. 12.8%, p\u0026thinsp;=\u0026thinsp;0.2063). Two deaths were recorded in total (3.0%), one in each group. Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e summarizes the occurrence of complications. No statistically significant differences in complication rates were observed between the groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of the occurence of complications in total group of patients, patients with T2DM and the control group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT2DM (N\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl (N\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory system complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (21.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (18.52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 (23.08%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7647\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurological or psychiatric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (13.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (11.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (15.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7270\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (15.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (25.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (7.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0773\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyocardial infarction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (6.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (11.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (2.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial fibrillation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (28.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (25.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (30.77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7850\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute kidney injury or exacerbation of chronic kidney disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (18.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (25.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (12.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (3.03%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (3.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (2.56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUnivariable logistic regression analysis demonstrated a significant positive association between Hcy levels and acute kidney injury or exacerbation of chronic kidney disease (OR [95% CI]\u0026thinsp;=\u0026thinsp;1.15 [1.03\u0026ndash;1.27], p\u0026thinsp;=\u0026thinsp;0.0099) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). There were no significant links between Hcy and respiratory, neurological, psychiatric, infectious, or atrial fibrillation complications (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between the level of homocystein and complications following CABG \u0026ndash; univariate logistic regression models.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of post-operative complications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute kidney injury or exacerbation of chronic kidney disease (yes)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.15 (1.03\u0026ndash;1.27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0099\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial fibrillation (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.02 (0.95\u0026ndash;1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5551\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfections (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.02 (0.93\u0026ndash;1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.7015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurological or psychiatric complications\u003c/p\u003e \u003cp\u003e(yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.07 (0.98\u0026ndash;1.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.1502\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory system complications (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.98 (0.89\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.6662\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe decided to assess correlation between postoperative complications and Hcy level in total study population because prevalence of complication was too low in particular groups. After adjustment for postoperative CRP, homocysteine remained independently associated with acute kidney injury or exacerbation of chronic kidney disease after CABG (OR [95% CI]\u0026thinsp;=\u0026thinsp;1.15 [1.03\u0026ndash;1.27], p\u0026thinsp;=\u0026thinsp;0.0099), while postoperative CRP was not independently associated with the outcome (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of homocysteine and postoperative CRP with acute kidney injury after CABG \u0026ndash; multivariate logistic regression model.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHomocystein [umol/l]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.13 (1.01\u0026ndash;1.26)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.0314\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP [mg/l] post-operative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.01 (1.00-1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.1378\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings confirmed that the association between Hcy levels and AKI or exacerbation of CKD occurs in both diabetic and non-diabetic patients undergoing surgical revascularization. These findings are consistent with previous research [16]. Other studies indicate that HHcy may exacerbate renal function through mitochondrial damage [17,18], oxidative stress, endothelial dysfunction, and microvascular injury [6,19]\u003c/p\u003e \u003cp\u003eWe did not divide subgroups by HHcy severity, as neither the study nor the control group exhibited HHcy (HHcy was defined as total Hcy concentrations\u0026thinsp;\u0026gt;\u0026thinsp;15 \u0026micro;mol/L [20]). Nevertheless, we observed a positive correlation between plasma Hcy levels and the incidence of AKI or exacerbation of CKD, suggesting that even modest elevations in Hcy may reflect subclinical metabolic or endothelial vulnerability. However, if we analyzed the level of Hcy in patients with renal complications, this group had higher plasma Hcy level (19,87 vs 12,06, see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) Statistical significance was not reached, probably due to small number of enrolled patients (12 with AKI or exacerbation of CKD)\u003c/p\u003e \u003cp\u003eZheng-Rong Li et al. also confirmed relation between higher levels of Hcy and AKI after cardiac surgery [21].\u003c/p\u003e \u003cp\u003eOther established risk factors for AKI include diabetes, aging, and heart failure [22]. In our cohort, we observed no difference in T2DM prevalence or age between those with and without AKI or exacerbation of CKD, and the age difference was not statistically significant. We also did not observe any association between HHcy and heart failure in either group.\u003c/p\u003e \u003cp\u003eIn addition, patients with HHcy exhibit increased inflammatory activity [23]. Inflammation is a well-established contributor to the development and progression of atherosclerosis. This provides a mechanistic link between metabolic disturbances and vascular injury [24,25]. HHcy also increases the risk of atherosclerosis, especially in individuals with end-stage renal failure [26]. Atherosclerosis can then promote further inflammation in the vascular wall. This creates a cycle in which HHcy, inflammation, and vascular injury fuel each other [25]. Jane Durga et al. in a double-blind, randomized, placebo-controlled trial showed that lowering slightly elevated Hcy concentrations, by 1-year folic acid supplementation, doesn't change the inflamatory state [27].\u003c/p\u003e \u003cp\u003eElevated Hcy levels may serve as an additional biomarker of renal vulnerability to damage after CABG. This is clinically important because AKI significantly increases in-hospital mortality and may lead to CKD [28,29]. In addition, folic acid supplementation lowers Hcy levels, suggesting that Hcy may be a modifiable risk factor [27,30,31].\u003c/p\u003e \u003cp\u003eFurthermore, in animal models, folic acid supplementation improved renal parameters during AKI [32]. Conversely, administration of high doses of folic acid is a method to induce acute kidney injury, a condition widely recognized as folic acid\u0026ndash;induced nephropathy [33,34]. Conditions such as vitamin cofactor deficiency, enzyme deficiency (including MTHFR variants), or increased methionine intake are known causes of HHcy. [35,36]. It remains unclear to what extent Hcy levels are modifiable and how supplying Hcy-lowering substances (such as folic acid and vitamin B12) before and after surgery affects the incidence of AKI. Therefore, it is important to conduct further studies with the administration of folic acid and/or vitamin cofactors or their methylated forms (5-MTHF, methylocobalamin).\u003c/p\u003e \u003cp\u003eEmphasis should also be put on the genetical background of HHcy. Polymorphism of MTHFR gen is connected with HHcy. Waśkiewicz et al. showed that only T/T genotype is associated with increased level and cardiovascular risk (CV). Interestingly that study showed also high prevalence of folate deficiency in Polish population [37]. Results of some studies suggest that lowering Hcy level by supplementing folic acid doesn\u0026rsquo;t change CV [36,38]. The results suggest that Hcy may be only a symptom and does not necessarily contribute to an increased risk of AKI or cardiovascular disease, as does inflammation.\u003c/p\u003e \u003cp\u003eOur study has several limitations. First, the cohort was relatively small and derived from a single center. Larger, multicenter studies are needed to confirm our observations. Second, we did not measure folate or vitamin B12 levels, which are important cofactors influencing Hcy metabolism. Third, long-term outcomes and post-discharge kidney function were not assessed.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eHcy was significantly associated with AKI or exacerbation of CKD after CABG. Patients with AKI or exacerbation of CKD had higher Hcy levels (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). We suggest that higher preoperative Hcy levels may influence the prevalence of AKI or exacerbation of CKD independently of inflammatory status. Univariable regression showed that Hcy predicted AKI or exacerbation of CKD (odds ratio per \u0026micro;mol/L\u0026thinsp;\u0026gt;\u0026thinsp;4, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Hcy also correlated with adverse metabolic and inflammatory profiles: higher triglycerides, CRP, and C-peptide, and lower HDL cholesterol. However, no association between Hcy and heart failure was observed.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAKI \u0026mdash; Acute kidney injury\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;BMI \u0026mdash; Body mass index\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;CABG \u0026mdash; Coronary artery bypass grafting\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;CAD \u0026mdash; Coronary artery disease\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;CKD \u0026mdash; Chronic kidney disease\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;CKMB \u0026mdash; Creatine kinase myocardial band\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;CRP \u0026mdash; C-reactive protein\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;CV \u0026mdash; Cardiovascular\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;HbA1c \u0026mdash; Glycated hemoglobin\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Hcy \u0026mdash; Homocysteine\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;HCT \u0026mdash; Hematocrit\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;HDL \u0026mdash; High-density lipoprotein\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;HHcy \u0026mdash; Hyperhomocysteinemia\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;HGB \u0026mdash; Hemoglobin\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;KDIGO \u0026mdash; Kidney Disease: Improving Global Outcomes\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;LDL \u0026mdash; Low-density lipoprotein\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;PLT \u0026mdash; Platelet count\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;STS \u0026mdash; Society of Thoracic Surgeons\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;T2DM \u0026mdash; Type 2 diabetes mellitus\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;WBC \u0026mdash; White blood cell\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank the participants of the study for their generous contributions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Cardiac Surgery, Medical University of Lodz, Lodz, Poland\u003c/p\u003e\n\u003cp\u003eAnna Marcinkiewicz, Wojciech Wiese, Michał Krejca\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDepartment of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland\u003c/p\u003e\n\u003cp\u003eAleksandra Ryk, Wojciech Fendler\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDepartment of Clinical Chemistry and Biochemistry, Medical University of Lodz, Lodz, Poland\u003c/p\u003e\n\u003cp\u003eWojciech Wiese\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA.M. conceived the study concept, coordinated patient recruitment, contributed to data acquisition, and drafted the initial version of the manuscript. A.R. performed statistical analyses and participated in data interpretation. W.W. visualized, formatted and edited the manuscript, and participated in data interpretation. M.K. contributed to patient recruitment, clinical data collection, and interpretation of surgical outcomes. W.F. supervised the statistical methodology, contributed to data interpretation, and critically revised the manuscript. All authors edited and approved the final version of the manuscript. \u0026nbsp;All authors contributed to the study design, reviewed and approved the final version of the manuscript, and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003eCorresponding author\u003c/p\u003e\n\u003cp\u003eAnna Marcinkiewicz, MD, Department of Cardiac Surgery, Medical University of Lodz, ul. Pomorska 251, Lodz, Poland, phone: +48 42 201 44 60\u003c/p\u003e\n\u003cp\u003eemail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki, and approved by the Bioethics\u003c/p\u003e\n\u003cp\u003eCommittee of the Medical University of Lodz, Poland (consent no. RNN/187/21/KE issued on 13.07.2021).\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants involved in the study.ARTICLE IN PRESS\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDal\u0026eacute;n M, Ivert T, Holzmann MJ, Sartipy U. Coronary artery bypass grafting in patients 50 years or younger: a Swedish nationwide cohort study. Circulation. 2015; 131: 1748-1754.\u003c/li\u003e\n\u003cli\u003eWang H, Ba Y, Cai R-C, Xing Q. Association between diabetes mellitus and the risk for major cardiovascular outcomes and all-cause mortality in women compared with men: a meta-analysis of prospective cohort studies. BMJ Open. 2019; 9: e024935.\u003c/li\u003e\n\u003cli\u003eZhao L, Hu H, Zhang L, et al. Inflammation in diabetes complications: molecular mechanisms and therapeutic interventions. MedComm (2020). 2024; 5: e516.\u003c/li\u003e\n\u003cli\u003eProspective Studies Collaboration and Asia Pacific Cohort Studies Collaboration. Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies. Lancet Diabetes Endocrinol. 2018; 6: 538-546.\u003c/li\u003e\n\u003cli\u003e\u0026Scaron;kovierov\u0026aacute; H, Vidomanov\u0026aacute; E, Mahmood S, et al. The Molecular and Cellular Effect of Homocysteine Metabolism Imbalance on Human Health. Int J Mol Sci. 2016; 17: 1733.\u003c/li\u003e\n\u003cli\u003eXu Y, Zhang N, Xu S, et al. Effects of phenytoin on serum levels of homocysteine, vitamin B12, folate in patients with epilepsy: A systematic review and meta-analysis (PRISMA-compliant article). Medicine (Baltimore). 2019; 98: e14844.\u003c/li\u003e\n\u003cli\u003eLi S, Sun L, Qi L, et al. Effect of High Homocysteine Level on the Severity of Coronary Heart Disease and Prognosis After Stent Implantation. J Cardiovasc Pharmacol. 2020; 76: 101-105.\u003c/li\u003e\n\u003cli\u003eWargny M, Croyal M, Ragot S, et al. Nutritional biomarkers and heart failure requiring hospitalization in patients with type 2 diabetes: the SURDIAGENE cohort. Cardiovasc Diabetol. 2022; 21: 101.\u003c/li\u003e\n\u003cli\u003eBalogh E, Maros T, Darag\u0026oacute; A, et al. Plasma homocysteine levels are related to medium-term venous graft degeneration in coronary artery bypass graft patients. Anatol J Cardiol. 2016; 16: 868-873.\u003c/li\u003e\n\u003cli\u003ePeng H, Man C, Xu J, Fan Y. Elevated homocysteine levels and risk of cardiovascular and all-cause mortality: a meta-analysis of prospective studies. J Zhejiang Univ Sci B. 2015; 16: 78-86.\u003c/li\u003e\n\u003cli\u003eThygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction (2018). Journal of the American College of Cardiology. 2018;\u003c/li\u003e\n\u003cli\u003eGlobal Guidelines for the Prevention of Surgical Site Infection. Geneva: World Health Organization, 2018.\u003c/li\u003e\n\u003cli\u003eAldecoa C, Bettelli G, Bilotta F, et al. Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients. Eur J Anaesthesiol. 2024; 41: 81-108.\u003c/li\u003e\n\u003cli\u003eSultan I, Bianco V, Kilic A, et al. Predictors and Outcomes of Ischemic Stroke After Cardiac Surgery. Ann Thorac Surg. 2020; 110: 448-456.\u003c/li\u003e\n\u003cli\u003eChadban SJ, Ahn C, Axelrod DA, et al. KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation. Transplantation. 2020; 104: S11-S103.\u003c/li\u003e\n\u003cli\u003eLi Z-R, Liu C-F, Guo D-Q, Wei Y-J. Association between serum homocysteine and postoperative acute kidney injury in patients undergoing cardiac surgery. Biomark Med. 2024; 18: 51-57.\u003c/li\u003e\n\u003cli\u003ePushpakumar S, Kundu S, Sen U. Hydrogen Sulfide Protects Hyperhomocysteinemia-Induced Renal Damage by Modulation of Caveolin and eNOS Interaction. Sci Rep. 2019; 9: 2223.\u003c/li\u003e\n\u003cli\u003eZhang M, Dong R, Da J, et al. Hyperhomocysteinemia exacerbates acute kidney injury via increased mitochondrial damage. Front Physiol. 2022; 13: 967104.\u003c/li\u003e\n\u003cli\u003eWargny M, Croyal M, Ragot S, et al. Nutritional biomarkers and heart failure requiring hospitalization in patients with type 2 diabetes: the SURDIAGENE cohort. Cardiovasc Diabetol. 2022; 21: 101.\u003c/li\u003e\n\u003cli\u003eYang B, Fan S, Zhi X, et al. Prevalence of hyperhomocysteinemia in China: a systematic review and meta-analysis. Nutrients. 2014; 7: 74-90.\u003c/li\u003e\n\u003cli\u003eLi Z-R, Liu C-F, Guo D-Q, Wei Y-J. Association between serum homocysteine and postoperative acute kidney injury in patients undergoing cardiac surgery. Biomark Med. 2024; 18: 51-57.\u003c/li\u003e\n\u003cli\u003eMatějka J, Varvařovsk\u0026yacute; I, Rozs\u0026iacute;val V, et al. Heart failure is the strongest predictor of acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Kardiol Pol. 2016; 74: 18-24.\u003c/li\u003e\n\u003cli\u003eZhang S, Lv Y, Luo X, et al. Homocysteine promotes atherosclerosis through macrophage pyroptosis via endoplasmic reticulum stress and calcium disorder. Mol Med. 2023; 29: 73.\u003c/li\u003e\n\u003cli\u003eStrijdhorst A, Vos WG, Bosmans LA, et al. Accelerated atherosclerosis associated with immune checkpoint inhibitors: a systematic review and meta-analysis of pre-clinical studies. Atherosclerosis. 2025; 405: 119219.\u003c/li\u003e\n\u003cli\u003eAjoolabady A, Pratico D, Lin L, et al. Inflammation in atherosclerosis: pathophysiology and mechanisms. Cell Death Dis. 2024; 15: 817.\u003c/li\u003e\n\u003cli\u003eRobinson K, Gupta A, Dennis V, et al. Hyperhomocysteinemia Confers an Independent Increased Risk of Atherosclerosis in End-Stage Renal Disease and Is Closely Linked to Plasma Folate and Pyridoxine Concentrations. Circulation. 1996; 94: 2743-2748.\u003c/li\u003e\n\u003cli\u003eDurga J, van Tits LJH, Schouten EG, et al. Effect of lowering of homocysteine levels on inflammatory markers: a randomized controlled trial. Arch Intern Med. 2005; 165: 1388-1394.\u003c/li\u003e\n\u003cli\u003ePalomba H, Castro I, Yu L, Burdmann EA. The duration of acute kidney injury after cardiac surgery increases the risk of long-term chronic kidney disease. J Nephrol. 2017; 30: 567-572.\u003c/li\u003e\n\u003cli\u003eHoste EAJ, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015; 41: 1411-1423.\u003c/li\u003e\n\u003cli\u003eGonz\u0026aacute;lez-Lamu\u0026ntilde;o D, Arrieta-Blanco FJ, Fuentes ED, et al. Hyperhomocysteinemia in Adult Patients: A Treatable Metabolic Condition. Nutrients. 2023; 16: 135.\u003c/li\u003e\n\u003cli\u003eDeminice R, Padilha C de S, Borges F, et al. Resistance exercise prevents impaired homocysteine metabolism and hepatic redox capacity in Walker-256 tumor-bearing male Wistar rats. Nutrition. 2016; 32: 1153-1158.\u003c/li\u003e\n\u003cli\u003eWijerathne CUB, Au-Yeung KKW, Siow YL, O K. 5-Methyltetrahydrofolate Attenuates Oxidative Stress and Improves Kidney Function in Acute Kidney Injury through Activation of Nrf2 and Antioxidant Defense. Antioxidants. 2022; 11: 1046.\u003c/li\u003e\n\u003cli\u003eKaterelos M, Ratnayake C, Gleich K, et al. Obesity Augments Necroinflammation and Worsens Injury With Folic Acid-Induced Acute Kidney Injury. FASEB J. 2025; 39: e71288.\u003c/li\u003e\n\u003cli\u003eBattaglia-Vieni A, Marchant V, Tejedor-Santamaria L, et al. Dasatinib and Quercetin Combination Increased Kidney Damage in Acute Folic Acid-Induced Experimental Nephropathy. Pharmaceuticals. 2025; 18: 822.\u003c/li\u003e\n\u003cli\u003eGlowacki R, Jakubowski H. Cross-talk between Cys34 and lysine residues in human serum albumin revealed by N-homocysteinylation. J Biol Chem. 2004; 279: 10864-10871.\u003c/li\u003e\n\u003cli\u003eUndas A, Stepień E, Glowacki R, et al. Folic acid administration and antibodies against homocysteinylated proteins in subjects with hyperhomocysteinemia. Thromb Haemost. 2006; 96: 342-347.\u003c/li\u003e\n\u003cli\u003eWaśkiewicz A, Piotrowski W, Broda G, et al. Impact of MTHFR C677T gene polymorphism and vitamins intake on homocysteine concentration in the Polish adult population. Kardiol Pol. 2011; 69: 1259-1264.\u003c/li\u003e\n\u003cli\u003eJardine MJ, Kang A, Zoungas S, et al. The effect of folic acid based homocysteine lowering on cardiovascular events in people with kidney disease: systematic review and meta-analysis. BMJ. 2012; 344: e3533.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"homocysteine, coronary artery bypass grafting, diabetes mellitus, acute kidney injury","lastPublishedDoi":"10.21203/rs.3.rs-8709727/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8709727/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003e\u003cbr\u003e\nElevated homocysteine (Hcy) has been linked to endothelial dysfunction and adverse cardiovascular outcomes. However, its specific role in patients with type 2 diabetes mellitus (T2DM) undergoing coronary artery bypass grafting (CABG) is not well established.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003cbr\u003e\nWe conducted a prospective analysis of 66 patients (27 with T2DM, 39 controls) who underwent elective CABG. Clinical, biochemical, and postoperative data were collected for all participants. Spearman’s correlation assessed associations between Hcy and laboratory parameters, while univariable and multivariable logistic regression examined relationships with complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cbr\u003e\nPreoperative median Hcy levels were similar in T2DM patients and controls (12.6 vs. 12.1 µmol/L, p = 0.24). In the total cohort, Hcy showed positive correlations with triglycerides (r = 0.39, p = 0.0018), C-peptide (r = 0.33, p = 0.0086), and CRP (r = 0.29, p = 0.0210), and a negative correlation with HDL cholesterol (r = –0.31, p = 0.0149). Higher Hcy levels were significantly associated with acute kidney injury (AKI) or exacerbation of chronic kidney disease (CKD) after CABG (b = 7.14, SE = 2.11, b⁎ = 0.40, p = 0.0013).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003cbr\u003e\nElevated preoperative Hcy levels were associated with postoperative renal complications after CABG. Therefore, Hcy may serve as a potential biomarker of AKI or exacerbation of CKD after CABG.\u003c/p\u003e","manuscriptTitle":"Does preoperative homocysteine level influence the postoperative period in diabetic or non-diabetic patients undergoing coronary artery bypass grafting?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 13:14:23","doi":"10.21203/rs.3.rs-8709727/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-04T09:09:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-03T02:10:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-02T23:04:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"23690581015241692612738733977545171387","date":"2026-02-18T21:50:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"293961133858662116739896960692631355643","date":"2026-02-16T18:14:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-16T09:18:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-13T10:35:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-12T07:29:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"195477253341943102777813722117455675793","date":"2026-02-10T16:05:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121959779481199267205639791608928096567","date":"2026-02-07T16:20:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"201645439096140485236153290733443463387","date":"2026-02-05T14:48:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-05T13:44:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-28T11:22:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-28T07:36:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-28T07:33:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2026-01-27T11:00:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ecb8c595-39a4-4a6e-b858-dbc10118aa88","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T08:08:24+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 13:14:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8709727","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8709727","identity":"rs-8709727","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}