Moorthy Vikaesh, Sim Ming Ann, Liu Weiling, Chew Sophia Tsong Huey, Ti Lian Kah
Yong Loo Lin School of Medicine, National University of Singapore.
Department of Anaesthesia, National University Hospital.
Medicine (Baltimore). 2019 Jun;98(23):e15911. doi: 10.1097/MD.0000000000015911.
Cardiac surgery induces a significant inflammatory hypermetabolic stress response, resulting in postoperative hyperglycemia in both preoperatively diabetic and nondiabetic patients. Such postoperative hyperglycemia has been associated with adverse outcomes in surgery and postsurgical recovery. Yet, while diabetes is a known risk factor for postoperative hyperglycemia, predictors of postoperative hyperglycemia among nondiabetics in the local Southeast Asian population remain unknown.We aim to investigate the predictors and outcomes associated with hyperglycemia after cardiac surgery among nondiabetics in the local Southeast Asian population. We analyzed data from 1602 nondiabetic adult patients undergoing elective cardiac surgery, from 2008 to 2010 at the 2 main heart centers in Singapore.Nondiabetic patients who developed postoperative hyperglycemia tended to be women, older, more obese, and hypertensive. Higher body mass index (BMI), age, aortic cross-clamp time, and blood transfusion were identified as independent risk factors of postoperative hyperglycemia. Postoperative hyperglycemia was also significantly associated with postoperative cardiac arrhythmias (26.9% vs 15.0%, P < .001), acute kidney injury (30.0% vs 20.1%, P < .001), longer intensive care unit (ICU) stay (46.7 ± 104.1 vs 37.2 ± 76.6 hours, P = .044) and longer hospitalization (11.5 ± 12.2 vs 9.6 ± 8.0 days, P < .001).Our study identified aortic cross-clamp time and blood transfusion as independent risk factors of postoperative hyperglycemia after cardiac surgery in nondiabetics. Similar to other studies, higher BMI and age were independent risk factors for postoperative hyperglycemia. Postoperative hyperglycemia was also associated with adverse perioperative outcomes and should thereby be avoided by treating modifiable risk factors identified in this study including reducing blood transfusion and aortic cross-clamp time. Our findings contribute to early risk stratification of nondiabetic patients who are at increased risk of postoperative hyperglycemia.
心脏手术会引发显著的炎症性高代谢应激反应，导致术前患有糖尿病和未患糖尿病的患者术后均出现高血糖。这种术后高血糖与手术及术后恢复的不良结局相关。然而，虽然糖尿病是术后高血糖的已知风险因素，但东南亚当地人群中非糖尿病患者术后高血糖的预测因素仍不明确。我们旨在调查东南亚当地人群中非糖尿病患者心脏手术后高血糖的预测因素及相关结局。我们分析了2008年至2010年在新加坡两个主要心脏中心接受择期心脏手术的1602例非糖尿病成年患者的数据。术后出现高血糖的非糖尿病患者往往为女性，年龄较大，更肥胖且患有高血压。较高的体重指数（BMI）、年龄、主动脉阻断时间和输血被确定为术后高血糖的独立风险因素。术后高血糖还与术后心律失常（26.9% 对15.0%，P<0.001）、急性肾损伤（30.0% 对20.1%，P<0.001）、重症监护病房（ICU）住院时间延长（46.7±104.1小时对37.2±76.6小时，P=0.044）以及住院时间延长（11.5±12.2天对9.6±8.0天，P<0.001）显著相关。我们的研究确定主动脉阻断时间和输血是非糖尿病患者心脏手术后术后高血糖的独立风险因素。与其他研究相似，较高的BMI和年龄是术后高血糖的独立风险因素。术后高血糖还与围手术期不良结局相关，因此应通过治疗本研究中确定的可改变风险因素来避免，包括减少输血和主动脉阻断时间。我们的研究结果有助于对术后高血糖风险增加的非糖尿病患者进行早期风险分层。
