Zhang Faqiang, Ma Yulong, Yu Yao, Sun Miao, Li Hao, Lou Jingsheng, Cao Jiangbei, Liu Yanhong, Niu Mu, Wang Long, Mi Weidong
School of Medicine, Nankai University, Tianjin, China.
Anesthesia and Operation Center, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
Front Aging Neurosci. 2022 Jan 11;13:810050. doi: 10.3389/fnagi.2021.810050. eCollection 2021.
Diabetes mellitus (DM) has been critically associated with unfavorable outcomes in the general population. We aimed to investigate the association between type 2 DM and long-term survival outcomes for postoperative ischemic stroke in patients who underwent non-cardiac surgery. This was a retrospective cohort study of patients with non-cardiac surgery who had suffered from postoperative ischemic stroke between January 2008 and August 2019. Diabetic individuals were included in postoperative ischemic stroke patients with the DM group. The outcome of interest was long-term overall survival (OS). We conducted propensity score matching (PSM) and inverse probability treatment weighting (IPTW) to adjust for baseline characteristic differences between groups. Multivariate Cox regression analysis with stepwise selection was used to calculate the adjusted hazard ratio (HR) of OS and type 2 DM. During a median follow-up of 46.2 month [interquartile range (IQR), 21.1, 84.2], 200 of 408 patients (49.0%) died. The OS rates at 3, 5, and 10 years were significantly lower for postoperative ischemic stroke patients with DM than those without DM (3 years OS: 52.2 vs. 69.5%, < 0.001; 5 years OS: 41.6 vs. 62.4%, < 0.001; 10 years OS: 37.2 vs. 56.6%, < 0.001). All covariates were between-group balanced after using PSM or IPTW. The postoperative ischemic stroke patients with type 2 DM had a shortened OS in primary analysis (HR: 1.947; 95% CI: 1.397-2.713; < 0.001), PSM analysis (HR: 2.190; 95% CI: 1.354-3.540; = 0.001), and IPTW analysis (HR: 2.551; 95% CI: 1.769-3.679; < 0.001). Type 2 DM was associated with an unfavorable survival outcome for postoperative ischemic stroke in patients who underwent non-cardiac surgery. When postoperative ischemic stroke co-occurred with type 2 DM, the potential synergies would have multiplicative mortality risk. Further research to assess the adverse effects of type 2 DM on long-term survival may be warranted.
糖尿病（DM）与普通人群的不良预后密切相关。我们旨在研究2型糖尿病与接受非心脏手术患者术后缺血性卒中的长期生存结局之间的关联。这是一项对2008年1月至2019年8月期间接受非心脏手术且发生术后缺血性卒中患者的回顾性队列研究。糖尿病个体被纳入DM组的术后缺血性卒中患者中。感兴趣的结局是长期总生存（OS）。我们进行了倾向评分匹配（PSM）和逆概率处理加权（IPTW）以调整组间的基线特征差异。采用逐步选择的多变量Cox回归分析来计算OS和2型糖尿病的调整后风险比（HR）。在中位随访46.2个月[四分位间距（IQR），21.1，84.2]期间，408例患者中有200例（49.0%）死亡。DM组术后缺血性卒中患者的3年、5年和10年OS率显著低于非DM组（3年OS：52.2%对69.5%，<0.001；5年OS：41.6%对62.4%，<0.001；10年OS：37.2%对56.6%，<0.001）。使用PSM或IPTW后，所有协变量在组间达到平衡。在初步分析（HR：1.947；95%CI：1.397 - 2.713；<0.001）、PSM分析（HR：2.190；95%CI：1.354 - 3.540；=0.001）和IPTW分析（HR：2.551；95%CI：1.769 - 3.679；<0.001）中，2型糖尿病患者术后缺血性卒中的OS缩短。2型糖尿病与接受非心脏手术患者术后缺血性卒中的不良生存结局相关。当术后缺血性卒中与2型糖尿病同时发生时，潜在的协同作用会带来成倍的死亡风险。可能有必要进行进一步研究以评估2型糖尿病对长期生存的不良影响。
