Gallagher Sean, Kapur Akhil, Lovell Matthew J, Jones Dan A, Kirkwood Amy, Hassan Sevda, Archbold R Andrew, Wragg Andrew, Uppal Rakesh, Yaqoob Muhammad M
Department of Cardiology, Barts Health NHS Trust, London, UK William Harvey Research Institute, Queen Mary and Westfield University, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK.
Department of Cardiology, Barts Health NHS Trust, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK.
Eur J Cardiothorac Surg. 2014 Jun;45(6):1075-81. doi: 10.1093/ejcts/ezt630. Epub 2014 Jan 20.
Diabetes mellitus (DM) and renal impairment (RI) are both independent predictors of mortality after coronary artery bypass graft surgery (CABG). The two conditions often coexist, yet the impact on long-term prognosis after CABG of each factor relative to the other and the two in combination is uncertain.
We undertook a prospective cohort study of 4869 patients who underwent CABG between 2003 and 2007. The cohort was divided into four groups according to preoperative diabetic status and renal function: patients without either DM or RI (reference group), patients with DM alone, patients with RI alone and patients with both DM and RI. Clinical outcomes were compared between groups. Patients receiving renal replacement therapy were excluded. The primary outcome was 5-year all-cause mortality.
The crude 5-year all-cause mortality rate was 9.0% for patients in the reference group, 11.1% for patients with DM alone, 20.3% for patients with RI alone and 28.5% for patients with both DM and RI (P < 0.0001). Five-year survival adjusted for potential confounding factors was significantly worse for patients with DM (hazard ratio (HR) 1.30; 95% confidence interval (CI) 1.06-1.59), patients with RI (HR 1.32; 95% CI 1.08-1.61) and patients with both DM and RI (HR 2.04; 95% CI 1.65-2.53) when compared with patients with neither condition.
Preoperative DM and RI were important predictors of 5-year mortality after CABG. Patients with RI alone had a higher mortality rate than patients with DM alone, but this difference was largely accounted for by age and other comorbidities. The combination of DM and RI doubled the 5-year mortality rate after CABG independently of potential confounding factors.
糖尿病（DM）和肾功能损害（RI）都是冠状动脉旁路移植术（CABG）后死亡率的独立预测因素。这两种情况常同时存在，但相对于彼此以及两者合并时，各因素对CABG术后长期预后的影响尚不确定。
我们对2003年至2007年间接受CABG的4869例患者进行了一项前瞻性队列研究。根据术前糖尿病状态和肾功能将队列分为四组：既无DM也无RI的患者（参照组）、仅患有DM的患者、仅患有RI的患者以及同时患有DM和RI的患者。比较各组的临床结局。排除接受肾脏替代治疗的患者。主要结局为5年全因死亡率。
参照组患者的5年粗全因死亡率为9.0%，仅患有DM的患者为11.1%，仅患有RI的患者为20.3%，同时患有DM和RI的患者为28.5%（P<0.0001）。与两种情况都没有的患者相比，经潜在混杂因素调整后的5年生存率在患有DM的患者中显著更差（风险比（HR）1.30；95%置信区间（CI）1.06 - 1.59），患有RI的患者中也是如此（HR 1.32；95%CI 1.08 - 1.61），同时患有DM和RI的患者中更是如此（HR 2.04；95%CI 1.65 - 2.53）。
术前DM和RI是CABG术后5年死亡率的重要预测因素。仅患有RI的患者比仅患有DM的患者死亡率更高，但这种差异在很大程度上由年龄和其他合并症所致。DM和RI的合并使CABG术后5年死亡率翻倍，且独立于潜在混杂因素。
