Li Xiaojue, Hou Xiaopei, Zhang Heng, Qian Xin, Feng Xinxing, Shi Na, Guo Rong, Sun Hansong, Feng Wei, Zhao Wei, Li Guangwei, Zheng Zhe, Chen Yanyan
Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Diabetes Obes Metab. 2023 Apr;25 Suppl 1:34-42. doi: 10.1111/dom.15013. Epub 2023 Mar 2.
To investigate the impact of stress hyperglycaemia (SH) on in-hospital adverse cardiac events after coronary artery bypass grafting (CABG) in patients without diabetes.
In total, 5450 patients without diabetes who underwent CABG were analysed. SH was defined as any two instances in which the random blood glucose level was >7.8 mmol/L after CABG in the intensive care unit (ICU). The primary outcome was major adverse cardiac events (MACEs), including in-hospital mortality, acute myocardial infarction, stroke and acute renal failure. Secondary outcomes included surgical site infection (SSI) and length of ICU stay.
Patients with SH had higher rates of MACEs (5.7% vs. 2.3%, p < .0001) and higher SSI (3.3% vs. 1.4%, p = .0003) and longer ICU stays (2.6 ± 2.0 vs. 1.3 ± 1.3 days, p < .0001) than those without SH. Furthermore, SH was associated with a higher risk of MACEs [odds ratio (OR): 2.32, 95% confidence interval (CI): 1.38-3.90], SSI (OR: 2.21, 95% CI: 1.20-3.95) and longer ICU stay (OR: 12.27, 95% CI: 9.41-16.92) after adjusting for confounders. Subgroup analysis showed that patients with SH >10 mmol/L or SH that occurred in the ICU and lasted more than 48 h had increased risks of postoperative complications (p < .05).
SH was significantly associated with an increased risk of MACEs, SSI and longer ICU stay after CABG in patients without diabetes. In addition, SH >10 mmol/L or that occurred in the ICU and lasted more than 48 h increased the risk of adverse outcomes.
研究应激性高血糖（SH）对非糖尿病患者冠状动脉旁路移植术（CABG）后院内不良心脏事件的影响。
共分析了5450例接受CABG的非糖尿病患者。SH定义为重症监护病房（ICU）中CABG后随机血糖水平>7.8 mmol/L的任意两次情况。主要结局为主要不良心脏事件（MACE），包括院内死亡、急性心肌梗死、中风和急性肾衰竭。次要结局包括手术部位感染（SSI）和ICU住院时间。
与无SH的患者相比，SH患者的MACE发生率更高（5.7%对2.3%，p <.0001）、SSI更高（3.3%对1.4%，p =.0003）且ICU住院时间更长（2.6±2.0天对1.3±1.3天，p <.0001）。此外，在调整混杂因素后，SH与MACE风险更高[比值比（OR）：2.32，95%置信区间（CI）：1.38 - 3.90]、SSI（OR：2.21，95% CI：1.20 - 3.95）和更长的ICU住院时间（OR：12.27，95% CI：9.41 - 16.92）相关。亚组分析显示，SH>10 mmol/L或发生在ICU且持续超过48小时的患者术后并发症风险增加（p <.05）。
SH与非糖尿病患者CABG后MACE风险增加、SSI和更长的ICU住院时间显著相关。此外，SH>10 mmol/L或发生在ICU且持续超过48小时会增加不良结局的风险。
