Department of Anesthesia and Intensive Care, Semmelweis University, Budapest, Hungary.
J Thorac Cardiovasc Surg. 2011 Aug;142(2):430-7.e1. doi: 10.1016/j.jtcvs.2011.03.009. Epub 2011 Apr 17.
The roles of perioperative hyperglycemia and diabetes in the risk stratification of patients undergoing coronary artery bypass graft surgery are unclear. The aim of this study is to explore the influence of perioperative hyperglycemia on postoperative mortality.
A prospective, observational study of 5050 patients undergoing cardiopulmonary bypass for coronary artery bypass graft surgery at 70 international centers was conducted, with 7500 measured variables per patient and outcomes adjudicated centrally. Postoperative blood glucose levels measured from the day of surgery to postoperative day 3 were available for 4799 patients. Multivariable logistic regression was used to determine the association of hyperglycemia with hospital mortality.
A total of 164 patients died during hospitalization (3.2%). Mortality was significantly higher in the diabetic population compared with the nondiabetic population (4.2% vs 2.9%; P = .02). In nondiabetic patients, maximum postoperative blood glucose between 250 and 300 mg/dL (adjusted odds ratio, 2.56; 95% confidence interval, 1.18-5.57; P = .02) and maximum blood glucose of 300 mg/dL or greater (adjusted odds ratio, 2.74; 95% confidence interval, 1.22-6.16; P = .01), compared with maximum blood glucose less than 200 mg/dL, and postoperative insulin treatment (adjusted odds ratio, 2.04; 95% confidence interval, 1.12-3.70), were independent risk factors for an increased risk of in-hospital mortality. In diabetic patients, hyperglycemia was not associated with a higher mortality risk.
Postoperative hyperglycemia is associated with increased in-hospital mortality in nondiabetic patients after coronary artery bypass graft surgery. In diabetic patients, hyperglycemia was not associated with mortality.
围手术期高血糖和糖尿病在接受冠状动脉旁路移植术患者的风险分层中的作用尚不清楚。本研究旨在探讨围手术期高血糖对术后死亡率的影响。
对 70 个国际中心 5050 例行体外循环冠状动脉旁路移植术的患者进行了前瞻性、观察性研究，每位患者有 7500 个测量变量，结局由中心裁定。4799 例患者的术后血糖水平从手术日测量到术后第 3 天。多变量逻辑回归用于确定高血糖与住院死亡率的关系。
共有 164 例患者在住院期间死亡（3.2%）。与非糖尿病患者相比，糖尿病患者的死亡率明显更高（4.2%比 2.9%；P=0.02）。在非糖尿病患者中，术后血糖最大值在 250 至 300mg/dL 之间（调整后的优势比，2.56；95%置信区间，1.18-5.57；P=0.02）和血糖最大值为 300mg/dL 或更高（调整后的优势比，2.74；95%置信区间，1.22-6.16；P=0.01），与血糖最大值低于 200mg/dL 相比，以及术后胰岛素治疗（调整后的优势比，2.04；95%置信区间，1.12-3.70），是住院死亡率增加的独立危险因素。在糖尿病患者中，高血糖与死亡率增加无关。
在接受冠状动脉旁路移植术的非糖尿病患者中，术后高血糖与住院期间死亡率增加有关。在糖尿病患者中，高血糖与死亡率无关。
