Safety and Glycemic Efficacy of Perioperative Liraglutide in Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Perioperative hyperglycemia in cardiac surgery is associated with wound infection, acute kidney injury, and death, yet the intravenous insulin used to treat it is itself coupled to hypoglycemia. Glucagon-like peptide-1 receptor agonists lower glucose only when glucose is elevated and might therefore separate glycemic control from hypoglycemic risk. We searched PubMed/MEDLINE, Scopus, Web of Science, and CENTRAL through September 2025 for randomized controlled trials of perioperative subcutaneous liraglutide versus placebo or insulin-based usual care in adults undergoing cardiac surgery. Two reviewers screened, extracted data, and applied the Cochrane Risk of Bias 2 tool independently; certainty was graded using GRADE. Effects were pooled by inverse variance, fixed-effect when I2 was below 50%. Seven reports of 4 trials, enrolling 446 randomized patients, were eligible. Liraglutide did not alter 30-day mortality (1/161 vs 3/160; risk ratio [RR] 0.42, 95% confidence interval [CI], 0.06-2.81), the composite of any postoperative complication (68/129 vs 76/132; RR 0.92; 95% CI, 0.74-1.14), cardiac adverse events (RR 1.08; 95% CI, 0.83-1.40), hypoglycemia (8/165 vs 9/166; RR 0.85; 95% CI, 0.34-2.13), or postoperative nausea and vomiting (RR 3.01; 95% CI, 0.26-35.27).