Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Urology Unit, ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy.
Urology. 2020 Jun;140:91-97. doi: 10.1016/j.urology.2020.02.019. Epub 2020 Mar 6.
To test the association between metabolic syndrome (MetS) and its components (high blood pressure, body mass index [BMI] ≥ 30, altered fasting glucose, low high-density lipoprotein cholesterol and high triglycerides) on perioperative outcomes after partial nephrectomy (PN).
Within the National Inpatient Sample database (2000-2015) we identified all PN patients. First, temporal trends of MetS were reported. Second, the effect of MetS components was tested in multivariable logistic regression models predicting overall and specific perioperative complications. Third, we tested for dose-response from the concomitant effect of multiple MetS components. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics.
Of 25,875 patients: (1) 59.3% had high blood pressure, (2) 14.7% had BMI ≥ 30, (3) 21.7% had altered fasting glucose, (4) 20.2% had high triglycerides, and (5) <0.01% had low high-density lipoprotein cholesterol. One vs 2 vs 3 vs 4 MetS components were recorded in 34.9% vs 22.9% vs 8.9% vs 2.2% patients. Of all, 11.1% exhibited ≥ 3 components and qualified for MetS. The rates of MetS increased over time (estimated annual percentage changes: +12.0%;P <.001). The 4 tested MetS components (high blood pressure, BMI ≥ 30, altered fasting glucose, and high triglycerides) achieved independent predictor status in multivariable models predicting overall, cardiac, miscellaneous medical, vascular, and respiratory complications, as well as transfusions. Moreover, a statistically significant dose-response was confirmed for the same endpoints.
MetS and its components consistently and strongly predict perioperative complications after PN. Moreover, the strength of the effect was directly proportional to the number of MetS components exhibited by each individual patient, even if formal MetS diagnosis of ≥ 3 components has not been met.
检验代谢综合征（MetS）及其各组分（高血压、体重指数[BMI]≥30、空腹血糖异常、低高密度脂蛋白胆固醇和高甘油三酯）与部分肾切除术（PN）后围手术期结局的相关性。
我们在国家住院患者样本数据库（2000-2015 年）中确定了所有接受 PN 的患者。首先，报告了 MetS 的时间趋势。其次，在多变量逻辑回归模型中检验了 MetS 各组分对总体和特定围手术期并发症的影响。第三，我们检验了多个 MetS 组分的伴随作用的剂量反应。所有模型均进行了加权，并根据聚类以及所有可用的患者和医院特征进行了调整。
在 25875 例患者中：（1）59.3%有高血压，（2）14.7%BMI≥30，（3）21.7%有空腹血糖异常，（4）20.2%有高甘油三酯，（5）<0.01%有低高密度脂蛋白胆固醇。1 个、2 个、3 个和 4 个 MetS 组分分别见于 34.9%、22.9%、8.9%和 2.2%的患者。所有患者中，11.1%存在≥3 个组分，符合 MetS 诊断。MetS 的发生率随时间增加（估计年百分比变化：+12.0%；P<.001）。在预测总体、心脏、其他内科、血管和呼吸系统并发症以及输血的多变量模型中，4 个测试的 MetS 组分（高血压、BMI≥30、空腹血糖异常和高甘油三酯）均成为独立预测因子。此外，还证实了对于相同结局的统计学显著剂量-反应关系。
MetS 及其各组分一致且强烈预测 PN 后围手术期并发症。此外，每个患者所表现出的 MetS 组分数量与效应强度成正比，即使未达到≥3 个组分的正式 MetS 诊断。
