Pang Qianyun, Feng Yumei, Yang Yajun, Liu Hongliang
Department of Anesthesiology, Chongqing University Cancer Hospital, Hanyu Road 181, Shapingba District, Chongqing, 400030, People's Republic of China.
Perioper Med (Lond). 2024 May 13;13(1):39. doi: 10.1186/s13741-024-00398-4.
Postoperative acute kidney injury (AKI) is a common and costly complication after non-cardiac surgery. Patients with or without diabetes could develop hyperglycemia before surgery, and preoperative hyperglycemia was closely associated with postoperative poor outcomes, but the association between preoperative fasting blood glucose level and postoperative AKI is still unclear.
Data from patients undergoing non-cardiac surgery in Chongqing University Cancer Hospital from January 1, 2017, to May 31, 2023, were collected, preoperative glucose value and perioperative variables were extracted, the primary exposure of interest was preoperative glucose value, and the outcome was postoperative AKI.
Data from 39,986 patients were included in the final analysis, 741(1.9%) patients developed AKI, 134(5.6%) in the cohort with DM, and 607(1.6%) in the cohort without DM(OR 1.312, 95% CI 1.028-1.675, P = 0.029). A significant non-linear association between preoperative glucose and AKI exists in the cohort without DM after covariable adjustment (P = 0.000), and every 1 mmol/L increment of preoperative glucose level increased OR by 15% (adjusted OR 1.150, 95% CI 1.078-1.227, P = 0.000), the optimal cut-point of preoperative fasting glucose level to predict AKI was 5.39 mmol/L (adjusted OR 1.802, 95%CI 1.513-2.146, P = 0.000). However, in the cohort with DM, the relation between preoperative glucose and postoperative AKI was not significant after adjusting by covariables (P = 0.437). No significance exists between both cohorts in the risk of AKI over the range of preoperative glucose values.
A preoperative fasting glucose value of 5.39 mmol/L can predict postoperative acute kidney injury after non-cardiac surgery in patients without diagnosed diabetes, but it is not related to AKI in patients with the diagnosis.
术后急性肾损伤（AKI）是非心脏手术后常见且代价高昂的并发症。无论有无糖尿病的患者在手术前都可能出现高血糖，术前高血糖与术后不良结局密切相关，但术前空腹血糖水平与术后AKI之间的关联仍不明确。
收集2017年1月1日至2023年5月31日在重庆大学附属肿瘤医院接受非心脏手术患者的数据，提取术前血糖值和围手术期变量，主要研究暴露因素为术前血糖值，结局为术后AKI。
最终分析纳入39986例患者的数据，741例（1.9%）发生AKI，糖尿病队列中有134例（5.6%），非糖尿病队列中有607例（1.6%）（比值比1.312，95%可信区间1.028 - 1.675，P = 0.029）。在非糖尿病队列中，经协变量调整后，术前血糖与AKI之间存在显著的非线性关联（P = 0.000），术前血糖水平每升高1 mmol/L，比值比增加15%（调整后比值比1.150，95%可信区间1.078 - 1.227，P = 0.000），预测AKI的术前空腹血糖水平最佳切点为5.39 mmol/L（调整后比值比1.802，95%可信区间1.513 - 2.146，P = 0.000）。然而，在糖尿病队列中，经协变量调整后，术前血糖与术后AKI之间的关系不显著（P = 0.437）。在术前血糖值范围内，两个队列在AKI风险方面无显著差异。
术前空腹血糖值5.39 mmol/L可预测未诊断糖尿病患者非心脏手术后的术后急性肾损伤，但与已诊断糖尿病患者的AKI无关。
