Depatment of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China; Medical School of Chinese People's Liberation Army, Beijing, China.
Depatment of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
Surgery. 2024 Nov;176(5):1433-1441. doi: 10.1016/j.surg.2024.07.034. Epub 2024 Aug 29.
The triglyceride-glucose index, a reliable surrogate biomarker of insulin resistance, has been reported to be associated with cardiovascular events and atherosclerosis. However, few studies have investigated the association of the triglyceride-glucose index with postoperative infections. This study aimed to study the clinical risk values of the preoperative triglyceride-glucose index in postoperative infection complications in elderly patients undergoing gastrointestinal-related abdominal and pelvic surgery.
This retrospective cohort study included 3,225 older patients who underwent gastrointestinal-related abdominal and pelvic surgery between 2014 and 2019. The patients were divided into groups of triglyceride-glucose index ≤8.268 and triglyceride-glucose index >8.268 according to the optimal triglyceride-glucose index cut-off value. The outcome of interest was postoperative infections within 30 days after surgery. Primary and subgroup analyses were performed to confirm that preoperative triglyceride-glucose index qualifies as a reliable, independent risk indicator. Propensity score matching analysis was further applied to address covariates' potential residual confounding effect and test the robustness of the results.
In this study, the median age was 71 years (interquartile range, 67, 75 years), the proportion of male patients was 66.3%, and 1,058 (32.8%) were infected within 30 days after surgery. A triglyceride-glucose index >8.268 was associated with an increased risk of postoperative infections in multivariate regression analysis (odds ratio, 1.37; 95% confidence interval, 1.15-1.64; P < .001). The correlation between the triglyceride-glucose index and postoperative infections remained significantly robust (odds ratio, 1.52; 95% confidence interval, 1.21-1.92; P < .001) in the propensity score matching analysis.
The triglyceride-glucose index elevation determined by the optimal cutoff value of 8.268 was an independent risk factor for developing postoperative infections.
三酰甘油-葡萄糖指数作为胰岛素抵抗的可靠替代生物标志物，已被报道与心血管事件和动脉粥样硬化有关。然而，很少有研究调查三酰甘油-葡萄糖指数与术后感染的关系。本研究旨在研究老年患者行胃肠相关腹部和盆腔手术后，术前三酰甘油-葡萄糖指数对术后感染并发症的临床风险值。
本回顾性队列研究纳入了 2014 年至 2019 年间行胃肠相关腹部和盆腔手术的 3225 名老年患者。根据最佳三酰甘油-葡萄糖指数截断值，患者分为三酰甘油-葡萄糖指数≤8.268 组和三酰甘油-葡萄糖指数>8.268 组。感兴趣的结局是手术后 30 天内的术后感染。进行了主要和亚组分析，以确认术前三酰甘油-葡萄糖指数是可靠的独立风险指标。进一步应用倾向评分匹配分析来解决协变量潜在的残余混杂效应，并检验结果的稳健性。
本研究中，患者的中位年龄为 71 岁（四分位距，67，75 岁），男性比例为 66.3%，30 天内有 1058 例（32.8%）发生感染。多变量回归分析显示，三酰甘油-葡萄糖指数>8.268 与术后感染风险增加相关（比值比，1.37；95%置信区间，1.15-1.64；P<0.001）。在倾向评分匹配分析中，三酰甘油-葡萄糖指数与术后感染之间的相关性仍然显著稳健（比值比，1.52；95%置信区间，1.21-1.92；P<0.001）。
通过 8.268 的最佳截断值确定的三酰甘油-葡萄糖指数升高是术后感染的独立危险因素。
