Department of General Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China.
Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Cardiovasc Diabetol. 2024 Nov 2;23(1):392. doi: 10.1186/s12933-024-02467-w.
There has been a concerning rise in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) following noncardiac surgeries (NCS), significantly impacting surgical outcomes and patient prognosis. Glucose metabolism abnormalities induced by stress response under acute medical conditions may be a risk factor for postoperative MACCE. This study aims to explore the association between stress hyperglycemia ratio (SHR) and postoperative MACCE in patients undergoing general anesthesia for NCS.
There were 12,899 patients in this perioperative cohort study. The primary outcome was MACCE within 30 days postoperatively, defined as angina, acute myocardial infarction, cardiac arrest, arrhythmia, heart failure, stroke, or in-hospital all-cause mortality. Kaplan-Meier curves visualized the cumulative incidence of MACCE. Cox proportional hazard models were utilized to assess the association between the risk of MACCE and different SHR groups. Restricted cubic spline analyses were conducted to explore potential nonlinear relationships. Additionally, exploratory subgroup analyses and sensitivity analyses were performed.
A total of 592 (4.59%) participants experienced MACCE within 30 days after surgery, and 1,045 (8.10%) within 90 days. After adjusting for confounding factors, compared to the SHR T2 group, the risk of MACCE within 30 days after surgery increased by 1.34 times (95% CI 1.08-1.66) in the T3 group and by 1.35 times (95% CI 1.08-1.68) in the T1 group respectively. In the non-diabetes group, the risk of MACCE within 30 days after surgery increased by 1.60 times (95% CI 1.21-2.12) in the T3 group and by 1.61 times (95% CI 1.21-2.14) in the T1 group respectively, while no statistically significant increase in risk was observed in the diabetes group. Similar results were observed within 90 days after surgery in the non-diabetes group. Additionally, a statistically significant U-shaped nonlinear relationship was observed in the non-diabetes group (30 days: P for nonlinear = 0.010; 90 days: P for nonlinear = 0.008).
In this large perioperative cohort study, we observed that both higher and lower SHR were associated with an increased risk of MACCE within 30 and 90 days after NCS, especially in patients without diabetes. These findings suggest that SHR potentially plays a key role in stratifying cardiovascular and cerebrovascular risk after NCS.
非心脏手术后（NCS）主要不良心脑血管事件（MACCE）的发生率令人担忧，这显著影响了手术结果和患者预后。急性医学情况下应激反应引起的葡萄糖代谢异常可能是术后 MACCE 的一个危险因素。本研究旨在探讨全麻下 NCS 患者应激血糖比（SHR）与术后 MACCE 的关系。
这是一项围手术期队列研究，共纳入了 12899 名患者。主要结局为术后 30 天内 MACCE，定义为心绞痛、急性心肌梗死、心脏骤停、心律失常、心力衰竭、中风或住院全因死亡率。Kaplan-Meier 曲线可视化 MACCE 的累积发生率。Cox 比例风险模型用于评估不同 SHR 组与 MACCE 风险之间的关系。限制性三次样条分析用于探讨潜在的非线性关系。此外，还进行了探索性亚组分析和敏感性分析。
共有 592 名（4.59%）患者在术后 30 天内发生 MACCE，1045 名（8.10%）患者在术后 90 天内发生 MACCE。在调整混杂因素后，与 SHR T2 组相比，SHR T3 组术后 30 天内发生 MACCE 的风险增加 1.34 倍（95%CI 1.08-1.66），SHR T1 组增加 1.35 倍（95%CI 1.08-1.68）。在非糖尿病组中，SHR T3 组术后 30 天内发生 MACCE 的风险增加 1.60 倍（95%CI 1.21-2.12），SHR T1 组增加 1.61 倍（95%CI 1.21-2.14），而糖尿病组无统计学显著增加风险。非糖尿病组在术后 90 天内也观察到类似的结果。此外，在非糖尿病组中观察到了统计学上显著的 U 形非线性关系（30 天：P 非线性=0.010；90 天：P 非线性=0.008）。
在这项大型围手术期队列研究中，我们观察到高 SHR 和低 SHR 均与 NCS 后 30 天和 90 天内 MACCE 风险增加相关，尤其是在无糖尿病患者中。这些发现表明 SHR 可能在 NCS 后心血管和脑血管风险分层中发挥关键作用。
