非心脏手术后接受胰岛素治疗与未接受胰岛素治疗的糖尿病患者的术后短期死亡率：一项系统评价和荟萃分析。
Postoperative short-term mortality between insulin-treated and non-insulin-treated patients with diabetes after non-cardiac surgery: a systematic review and meta-analysis.
作者信息
Jiang Jie, Wang Shuo, Sun Rao, Zhao Yilin, Zhou Zhiqiang, Bi Jiangjiang, Luo Ailin, Li Shiyong
机构信息
Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
Front Med (Lausanne). 2023 May 2;10:1142490. doi: 10.3389/fmed.2023.1142490. eCollection 2023.
BACKGROUND
Diabetes mellitus is an independent risk factor for postoperative complications. It has been reported that insulin-treated diabetes is associated with increased postoperative mortality compared to non-insulin-treated diabetes after cardiac surgery; however, it is unclear whether this finding is applicable to non-cardiac surgery.
OBJECTIVE
We aimed to assess the effects of insulin-treated and non-insulin-treated diabetes on short-term mortality after non-cardiac surgery.
METHODS
Our study was a systematic review and meta-analysis of observational studies. PubMed, CENTRAL, EMBASE, and ISI Web of Science databases were searched from inception to February 22, 2021. Cohort or case-control studies that provided information on postoperative short-term mortality in insulin-treated diabetic and non-insulin-treated diabetic patients were included. We pooled the data with a random-effects model. The Grading of Recommendations, Assessment, Development, and Evaluation system was used to rate the quality of evidence.
RESULTS
Twenty-two cohort studies involving 208,214 participants were included. Our study suggested that insulin-treated diabetic patients was associated with a higher risk of 30-day mortality than non-insulin-treated diabetic patients [19 studies with 197,704 patients, risk ratio (RR) 1.305; 95% confidence interval (CI), 1.127 to 1.511; < 0.001]. The studies were rated as very low quality. The new pooled result only slightly changed after seven simulated missing studies were added using the trim-and-fill method (RR, 1.260; 95% CI, 1.076-1.476; = 0.004). Our results also showed no significant difference between insulin-treated diabetes and non-insulin-treated diabetes regarding in-hospital mortality (two studies with 9,032 patients, RR, 0.970; 95% CI, 0.584-1.611; = 0.905).
CONCLUSION
Very-low-quality evidence suggests that insulin-treated diabetes was associated with increased 30-day mortality after non-cardiac surgery. However, this finding is non-definitive because of the influence of confounding factors.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021246752, identifier: CRD42021246752.
背景
糖尿病是术后并发症的独立危险因素。据报道，与心脏手术后非胰岛素治疗的糖尿病相比，胰岛素治疗的糖尿病与术后死亡率增加相关；然而，尚不清楚这一发现是否适用于非心脏手术。
目的
我们旨在评估胰岛素治疗和非胰岛素治疗的糖尿病对非心脏手术后短期死亡率的影响。
方法
我们的研究是对观察性研究的系统评价和荟萃分析。检索了从数据库建立至2021年2月22日的PubMed、CENTRAL、EMBASE和ISI Web of Science数据库。纳入提供胰岛素治疗糖尿病患者和非胰岛素治疗糖尿病患者术后短期死亡率信息的队列研究或病例对照研究。我们采用随机效应模型汇总数据。使用推荐分级、评估、制定和评价系统对证据质量进行评级。
结果
纳入了22项涉及208,214名参与者的队列研究。我们的研究表明，与非胰岛素治疗的糖尿病患者相比，胰岛素治疗的糖尿病患者30天死亡率风险更高[19项研究，共197,704名患者，风险比（RR）1.305；95%置信区间（CI）为1.127至1.511；P<0.001]。这些研究被评为极低质量。使用修剪填充法添加7项模拟缺失研究后，新的汇总结果仅略有变化（RR为1.260；95%CI为1.076 - 1.476；P = 0.004）。我们的结果还显示，胰岛素治疗的糖尿病和非胰岛素治疗的糖尿病在住院死亡率方面无显著差异（2项研究，共9,032名患者，RR为0.970；95%CI为0.584至1.611；P = 0.905）。
结论
极低质量的证据表明，胰岛素治疗的糖尿病与非心脏手术后30天死亡率增加相关。然而，由于混杂因素的影响，这一发现并不确定。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021246752，标识符：CRD42021246752。
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