Faculty of Health and Medical Science, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
Department of Medicine, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
J Diabetes. 2024 Oct;16(10):e70015. doi: 10.1111/1753-0407.70015.
The objective of this study was to evaluate the impact of dysglycemia on perioperative outcomes, in patients with and without diabetes, and how prior glycemic control modifies these relationships.
Consecutive surgical patients admitted to six South Australian tertiary hospitals between 2017 and 2023 were included. Blood glucose levels within 48 h pre- and post-operatively were assessed in an adjusted analyses against a priori selected covariates. Dysglycemia metrics were hyperglycemia (>10.0 mmol/L), hypoglycemia (<4.0 mmol/L), glycemic variability (standard deviation of mean blood glucose >1.7 mmol/L), and stress hyperglycemic ratio (SHR). The primary outcome was hospital mortality.
Of 52 145 patients, 7490 (14.4%) had recognized diabetes. Inpatient mortality was observed in 787 patients (1.5%), of which 150 (19.1%) had diabetes mellitus. Hyperglycemia was associated with increased mortality in patients with diabetes (odds ratio [OR] = 2.99, 95% CI: 1.63-5.67, p = 0.004) but not in non-diabetics, who instead had an increased odds of intensive care unit (ICU) admission if hyperglycemic (OR = 1.95, 95% CI: 1.40-2.72, p < 0.0001). Glycemic variability was associated with increased mortality in patients with diabetes (OR = 1.46, 95% CI: 1.05-2.01, p < 0.05) but not in non-diabetics. Preoperative glycemic control (HbA1c) attenuated both of these associations in a dose-dependent fashion. Hypoglycemia was associated with increased mortality in non-diabetics (OR = 2.14, 95% CI: 1.92-2.37, p < 0.001) but not in patients with diabetes.
CONCLUSIONS,: In surgical patients with diabetes, prior exposure to hyperglycemia attenuates the impact of perioperative hyperglycemia and glycemic variability on inpatient mortality and ICU admission. In patients without diabetes mellitus, all absolute thresholds of dysglycemia are associated with ICU admission, unlike those with diabetes, suggesting the need to use more relative measures such as the SHR.
本研究旨在评估围手术期结局在合并和不合并糖尿病的患者中受血糖异常的影响，以及术前血糖控制如何调节这些关系。
纳入了 2017 年至 2023 年期间在南澳大利亚州六家三级医院住院的连续手术患者。在调整分析中，将术前和术后 48 小时内的血糖水平与事先选择的协变量进行评估。血糖异常指标包括高血糖（>10.0mmol/L）、低血糖（<4.0mmol/L）、血糖变异性（平均血糖标准差>1.7mmol/L）和应激性高血糖比值（SHR）。主要结局是院内死亡率。
在 52145 名患者中，7490 名（14.4%）患有已知糖尿病。787 名患者（1.5%）观察到院内死亡，其中 150 名（19.1%）患有糖尿病。在合并糖尿病的患者中，高血糖与死亡率增加相关（比值比[OR]2.99，95%置信区间：1.63-5.67，p=0.004），但在非糖尿病患者中并非如此，高血糖患者更有可能入住重症监护病房（ICU）（OR 1.95，95%置信区间：1.40-2.72，p<0.0001）。血糖变异性与合并糖尿病患者的死亡率增加相关（OR 1.46，95%置信区间：1.05-2.01，p<0.05），但与非糖尿病患者无关。术前血糖控制（HbA1c）以剂量依赖性方式减弱了这两种关联。在非糖尿病患者中，低血糖与死亡率增加相关（OR 2.14，95%置信区间：1.92-2.37，p<0.001），但在合并糖尿病的患者中并非如此。
在合并糖尿病的手术患者中，术前高血糖暴露减轻了围手术期高血糖和血糖变异性对住院死亡率和 ICU 入住率的影响。在无糖尿病的患者中，所有血糖异常的绝对阈值都与 ICU 入住相关，与合并糖尿病的患者不同，这表明需要使用更相对的指标，如 SHR。
