Bahceci Mahir, Gulec Ersel, Turktan Mediha, Hatipoglu Zehra, Ozcengiz Dilek
Department of Anesthesiology and Reanimation, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey.
Medicina (Kaunas). 2025 Aug 16;61(8):1474. doi: 10.3390/medicina61081474.
: Diabetes is a known risk factor for postoperative delirium (POD); however, the relationship between the markers of glycemic control and the occurrence of POD in noncardiac surgery is not established. We initiated this pilot study to determine any possible associations between preoperative HbA1c levels and POD development; this will allow for larger, definitive studies to be designed and preliminary effect sizes to be established for future research. : This retrospective pilot study included 78 patients with diabetes who underwent elective noncardiac surgery under general anesthesia between July 2020 and January 2021. We obtained the patients' demographic data, medical history, surgical parameters, and preoperative HbA1c levels to determine the occurrence of POD (using CAM-ICU). Univariate and multivariate regression analyses were applied to check the leading associations for the development of POD. : POD was observed in seven patients (9.0%). The results of the preliminary multivariate analysis suggested that HbA1c may be associated with POD (OR, 2.96; 95% CI [1.34-6.52], = 0.007); fasting blood glucose (OR, 1.04; 95% CI [1.01-1.07], = 0.013); and duration of anesthesia (OR, 1.02; 95% CI [1.00-1.04], = 0.019). The ROC analysis of HbA1c showed an optimal threshold of 7.4%, with a sensitivity of 91.5%, and a specificity of 85.7% in terms of predicting POD (AUC = 0.91, < 0.001). : Through this pilot study, we have provided evidence that leads to the assumption that preoperative HbA1c at, or above, 7.4% can result in an increased risk of delirium in diabetic patients who undergo noncardiac surgery. The findings of this study allow for the implementation of the proposed methodology and the collection of critical data necessary for the design of appropriately powered definitive trials.
糖尿病是术后谵妄（POD）的已知危险因素；然而，血糖控制指标与非心脏手术中POD发生之间的关系尚未明确。我们开展了这项初步研究，以确定术前糖化血红蛋白（HbA1c）水平与POD发生之间的任何可能关联；这将有助于设计更大规模的确定性研究，并为未来研究确定初步效应量。：这项回顾性初步研究纳入了78例2020年7月至2021年1月期间在全身麻醉下接受择期非心脏手术的糖尿病患者。我们获取了患者的人口统计学数据、病史、手术参数和术前HbA1c水平，以确定POD的发生情况（使用CAM-ICU）。采用单因素和多因素回归分析来检查POD发生的主要关联因素。：7例患者（9.0%）出现POD。初步多因素分析结果表明，HbA1c可能与POD相关（比值比[OR]，2.96；95%置信区间[CI][1.34 - 6.52]，P = 0.007）；空腹血糖（OR，1.04；95% CI[1.01 - 1.07]，P = 0.013）；以及麻醉持续时间（OR，1.02；95% CI[1.00 - 1.04]，P = 0.019）。HbA1c的ROC分析显示，预测POD的最佳阈值为7.4%，敏感性为91.5%，特异性为85.7%（曲线下面积[AUC] = 0.91，P < 0.001）。：通过这项初步研究，我们提供了证据，支持术前HbA1c达到或高于7.4%会增加接受非心脏手术的糖尿病患者谵妄风险的假设。本研究结果有助于实施所提出的方法，并收集设计有足够效力的确定性试验所需的关键数据。
