Kim Sojin, Park Jungchan, Kim Hara, Yang Kwangmo, Choi Jin-Ho, Kim Kyunga, Sung Jidong, Ahn Joonghyun, Lee Seung-Hwa
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Korea.
J Clin Med. 2021 Nov 9;10(22):5219. doi: 10.3390/jcm10225219.
Hyperglycemia in surgical candidates is associated with increased mortality and morbidity. We aimed to evaluate the effect of intraoperative blood glucose level on the incidence of myocardial injury after non-cardiac surgery (MINS) in diabetic patients.
Diabetic patients with available intraoperative blood glucose measurement during non-cardiac surgery were enrolled in this study. Based on the highest intraoperative blood glucose level, patients were stratified into two groups: the blood sugar glucose (BST) < 180 group (intraoperative peak glucose < 180 mg/dL) and BST ≥ 180 group (intraoperative peak glucose ≥ 180 mg/dL). The primary outcome was the incidence of MINS, and secondary outcomes were in-hospital and 30-day mortalities.
Of the 11,302 diabetic patients, 8337 were in the BST < 180 group (73.8%) and 2965 in the BST ≥ 180 group (26.2%). After adjustment with inverse probability weighting, MINS was significantly higher in the BST ≥ 180 group (24.0% vs. 17.2%; odds ratio (OR), 1.26; 95% confidence interval (CI), 1.14-1.40; < 0.001). In addition, in-hospital and 30-day mortalities were also higher in the BST ≥ 180 group compared to the BST < 180 group (4.2% vs. 2.3%, hazard ratio (HR), 1.39; 95% CI, 1.07-1.81; = 0.001, and 3.1% vs. 1.8%; HR, 1.76; 95% CI, 1.31-2.36; < 0.001, respectively). Receiver-operating characteristic plots showed that the threshold of glucose level associated with MINS was 149 mg/dL.
Intraoperative hyperglycemia was associated with an increased MINS incidence and postoperative mortality in diabetic patients. Close monitoring of intraoperative blood glucose level may be helpful in detection and management of MINS.
手术候选患者的高血糖与死亡率和发病率增加相关。我们旨在评估术中血糖水平对糖尿病患者非心脏手术后心肌损伤（MINS）发生率的影响。
纳入在非心脏手术期间有术中血糖测量值的糖尿病患者。根据术中最高血糖水平，将患者分为两组：血糖（BST）<180组（术中峰值血糖<180mg/dL）和BST≥180组（术中峰值血糖≥180mg/dL）。主要结局是MINS的发生率，次要结局是住院期间和30天死亡率。
在11302例糖尿病患者中，8337例在BST<180组（73.8%），2965例在BST≥180组（26.2%）。经逆概率加权调整后，BST≥180组的MINS明显更高（24.0%对17.2%；比值比（OR），1.26；95%置信区间（CI），1.14 - 1.40；<0.001）。此外，与BST<180组相比，BST≥180组的住院期间和30天死亡率也更高（4.2%对2.3%，风险比（HR），1.39；95%CI，1.07 - 1.81；=0.001，以及3.1%对1.8%；HR，1.76；95%CI，1.31 - 2.36；<0.001）。受试者操作特征曲线显示，与MINS相关的血糖水平阈值为149mg/dL。
术中高血糖与糖尿病患者MINS发生率增加和术后死亡率增加相关。密切监测术中血糖水平可能有助于MINS的检测和管理。
