Department of Surgery, Vascular and Trauma Surgery, Hamad General Hospital, Doha, Qatar.
Department of Surgery, Hamad General Hospital, Doha, Qatar.
Curr Vasc Pharmacol. 2019;17(4):354-364. doi: 10.2174/1570161116666180123112529.
We hypothesized that perioperative HbA1c influenced the pattern and outcomes of Lower Extremity Amputation (LEA).
A retrospective analysis was conducted for all patients who underwent LEA between 2000 and 2013. Patients were categorized into 5 groups according to their perioperative HbA1c values [Group 1 (<6.5%), Group 2 (6.5-7.4%), Group 3 (7.5-8.4%), Group 4 (8.5-9.4%) and Group 5 (≥9.5%)]. We identified 848 patients with LEA; perioperative HbA1c levels were available in 547 cases (Group 1: 18.8%, Group 2: 17.7%, Group 3: 15.0%, Group 4: 13.5% and Group 5: 34.9%). Major amputation was performed in 35%, 32%, 22%, 10.8% and 13.6%, respectively.
The overall mortality was 36.5%; of that one quarter occurred during the index hospitalization. Mortality was higher in Group 1 (57.4%) compared with Groups 2-5 (46.9%, 38.3%, 36.1% and 31.2%, respectively, p=0.001). Cox regression analysis showed that poor glycemic control (Group 4 and 5) had lower risk of mortality post-LEA [hazard ratio 0.57 (95% CI 0.35-0.93) and hazard ratio 0.46 (95% CI 0.31-0.69)]; this mortality risk persisted even after adjustment for age and sex but was statistically insignificant. The rate of LEA was greater among poor glycemic control patients; however, the mortality was higher among patients with tight control.
The effects of HbA1c on the immediate and long-term LEA outcomes and its therapeutic implications need further investigation.
我们假设围手术期的糖化血红蛋白（HbA1c）会影响下肢截肢（LEA）的模式和结局。
对 2000 年至 2013 年间接受 LEA 的所有患者进行回顾性分析。根据围手术期 HbA1c 值将患者分为 5 组[第 1 组（<6.5%）、第 2 组（6.5-7.4%）、第 3 组（7.5-8.4%）、第 4 组（8.5-9.4%）和第 5 组（≥9.5%）]。我们共确定了 848 例接受 LEA 的患者，其中 547 例患者（第 1 组：18.8%、第 2 组：17.7%、第 3 组：15.0%、第 4 组：13.5%和第 5 组：34.9%）的围手术期 HbA1c 水平可用。主要截肢分别在 35%、32%、22%、10.8%和 13.6%的患者中进行。
总的死亡率为 36.5%，其中四分之一的患者在指数住院期间死亡。第 1 组（57.4%）的死亡率明显高于第 2-5 组（46.9%、38.3%、36.1%和 31.2%，p=0.001）。Cox 回归分析显示，血糖控制不佳（第 4 组和第 5 组）的患者 LEA 后死亡风险较低[风险比 0.57（95%可信区间 0.35-0.93）和风险比 0.46（95%可信区间 0.31-0.69）]；即使在调整了年龄和性别后，这种死亡率风险仍然存在，但统计学上并不显著。血糖控制不佳的患者 LEA 发生率更高，但死亡率更高。
HbA1c 对立即和长期 LEA 结局的影响及其治疗意义需要进一步研究。
