Chen Lihai, Sun Jie, Kong Siyu, Tan Qilian, Liu Xuesheng, Cheng Yi, Yang Fan, Yin Xuan, Zhang Chen, Liu Jiacong, Hu Lanxin, Ge Yali, Shi Hongwei, Zhou Jifang
Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China.
Department of Anesthesiology, Zhongda Hospital, Southeast University, Nanjing, China.
J Clin Anesth. 2025 Jan;100:111706. doi: 10.1016/j.jclinane.2024.111706. Epub 2024 Nov 26.
No previous research has specifically investigated the relationship between postoperative glycemic variability (GV) and acute kidney disease (AKD) in patients undergoing cardiac surgery. In this study, several methods of modelling postoperative GV were used to examine the association between GV and AKD risk and subtypes of AKD.
We undertook a retrospective study involving a total of 8,090 adult patients from three academic medical centers in Eastern China who underwent cardiac surgery with cardiopulmonary bypass between 2015 and 2023. Seven-day postoperative GV was calculated using the standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE), average daily risk range (ADRR), and time out of target range (TOR). The primary focus was on the occurrence of AKD between 8 and 90 days post-surgery, which was further categorized into persistent AKD and delayed AKD depending on the acute kidney injury (AKI) status in the first 7 days.
During the 8-90 days postoperative period, AKD occurred in 522 out of 8,090 patients (6.5%). Seven-day postoperative GV was significantly and consistently higher in the AKD group (p<0.001 for each metric). After adjusting for relevant covariates, 7-day GV metrics were significantly associated with elevated AKD risk (standardized hazard ratio (SHR):1.20 (95% confidence interval (CI): (1.12 - 1.27) for SD; SHR: 1.30 (95% CI: 1.20 - 1.40) for TOR). GV was correlated with persistent AKD, while no statistically significant association was observed between GV and delayed AKD. Unique cutoff thresholds were calculated for each GV metric to provide a quantitative indicator of high GV, enhancing its practical utility.
Our study highlights the association between postoperative GV and increased AKD risk, and identifies specific GV thresholds in adults undergoing cardiac surgery.
既往尚无研究专门调查心脏手术患者术后血糖变异性（GV）与急性肾脏病（AKD）之间的关系。在本研究中，我们采用了几种术后GV建模方法来检验GV与AKD风险及AKD亚型之间的关联。
我们进行了一项回顾性研究，纳入了来自中国东部三个学术医疗中心的8090例成年患者，这些患者在2015年至2023年间接受了体外循环心脏手术。术后7天的GV采用标准差（SD）、变异系数（CV）、血糖波动幅度均值（MAGE）、平均每日风险范围（ADRR）和超出目标范围时间（TOR）进行计算。主要关注术后8至90天内AKD的发生情况，并根据术后第1周的急性肾损伤（AKI）状态进一步分为持续性AKD和延迟性AKD。
在术后8至90天期间，8090例患者中有522例（6.5%）发生了AKD。AKD组术后7天的GV显著且持续更高（各指标p<0.001）。在调整相关协变量后，7天GV指标与AKD风险升高显著相关（标准化风险比（SHR）：SD为1.20（95%置信区间（CI）：1.12 - 1.27）；TOR为1.30（95%CI：1.20 - 1.40））。GV与持续性AKD相关，而未观察到GV与延迟性AKD之间存在统计学显著关联。为每个GV指标计算了独特的临界阈值，以提供高GV的定量指标，增强其实用性。
我们的研究强调了术后GV与AKD风险增加之间的关联，并确定了心脏手术成年患者的特定GV阈值。
