Kong Siyu, Ding Ke, Jiang Huili, Yang Fan, Zhang Chen, Han Liu, Ge Yali, Chen Lihai, Shi Hongwei, Zhou Jifang
From the School of International Business, China Pharmaceutical University, Jiangsu, China.
Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China.
Anesth Analg. 2025 Mar 1;140(3):636-645. doi: 10.1213/ANE.0000000000007131. Epub 2025 Feb 14.
While the relationship between glycemic variability (GV) and acute kidney injury (AKI) has been a subject of interest, the specific association of GV with persistent AKI beyond 48 hours postoperative after noncardiac surgery is not well-established.
This retrospective cohort study aimed to describe the patterns of different GV metrics in the immediate 48 hours after noncardiac surgery, evaluate the association between GV indices and persistent AKI within the 7-day postoperative window, and compare the risk identification capabilities of various GV for persistent AKI. A total of 10,937 patients who underwent major noncardiac surgery across 3 medical centers in eastern China between January 2015 and September 2023 were enrolled. GV was characterized using the coefficient of variations (CV), mean amplitude of glycemic excursions (MAGE), and the blood glucose risk index (BGRI). Multivariable logistic regression was used to examine the relationship between GV and AKI. Optimal cutoff values for GV metrics were calculated through the risk identification models, and an independent cohort from the INformative Surgical Patient dataset for Innovative Research Environment (INSPIRE) database with 7714 eligible cases served to externally validate the risk identification capability.
Overall, 274 (2.5%) of the 10,937 patients undergoing major noncardiac surgery met the criteria of persistent AKI. Higher GV was associated with an increased risk of persistent AKI (CV: odds ratio [OR] = 1.26, 95% confidence interval [CI], 1.08-1.46; MAGE: OR = 1.31, 95% CI, 1.15-1.49; BGRI: OR = 1.18, 95% CI, 1.08-1.29). Compared to models that did not consider glycemic factors, MAGE and BGRI independently contributed to predicting persistent AKI (MAGE: areas under the curve [AUC] = 0.768, P = .011; BGRI: AUC = 0.764, P = .014), with cutoff points of 3.78 for MAGE, and 3.02 for BGRI. The classification of both the internal and external validation cohorts using cutoffs demonstrated good performance, achieving the best AUC values of 0.768 for MAGE in the internal cohort and 0.777 for MAGE in the external cohort.
GV measured within 48 hours postoperative period is an independent risk factor for persistent AKI in patients undergoing noncardiac surgery. Specific cutoff points can be used to stratify at-risk patients. These findings indicate that stabilizing GV may potentially mitigate adverse kidney outcomes after noncardiac surgery, highlighting the importance of glycemic control in the perioperative period.
虽然血糖变异性（GV）与急性肾损伤（AKI）之间的关系一直是研究热点，但GV与非心脏手术后48小时以上持续性AKI的具体关联尚未明确。
这项回顾性队列研究旨在描述非心脏手术后即刻48小时内不同GV指标的模式，评估GV指标与术后7天内持续性AKI之间的关联，并比较各种GV指标对持续性AKI的风险识别能力。纳入了2015年1月至2023年9月在中国东部3个医疗中心接受大型非心脏手术的10937例患者。使用变异系数（CV）、血糖波动平均幅度（MAGE）和血糖风险指数（BGRI）来表征GV。采用多变量逻辑回归分析GV与AKI之间的关系。通过风险识别模型计算GV指标的最佳截断值，并使用来自创新研究环境信息手术患者数据集（INSPIRE）数据库的7714例符合条件的独立队列进行外部验证风险识别能力。
总体而言，10937例接受大型非心脏手术的患者中有274例（2.5%）符合持续性AKI标准。较高的GV与持续性AKI风险增加相关（CV：比值比[OR]=1.26，95%置信区间[CI]，1.08 - 1.46；MAGE：OR = 1.31，95%CI，1.15 - 1.49；BGRI：OR = 1.18，95%CI，1.08 - 1.29）。与未考虑血糖因素的模型相比，MAGE和BGRI独立有助于预测持续性AKI（MAGE：曲线下面积[AUC]=0.768，P = 0.011；BGRI：AUC = 0.764，P = 0.014），MAGE的截断点为3.78，BGRI的截断点为3.02。使用截断值对内部和外部验证队列进行分类显示出良好的性能，内部队列中MAGE的最佳AUC值为0.768，外部队列中MAGE的最佳AUC值为0.777。
术后48小时内测得的GV是接受非心脏手术患者发生持续性AKI的独立危险因素。可以使用特定的截断点对高危患者进行分层。这些发现表明，稳定GV可能潜在减轻非心脏手术后的不良肾脏结局，突出了围手术期血糖控制的重要性。
