Incidence of sodium-glucose cotransporter-2 inhibitor-associated perioperative ketoacidosis in surgical patients: a prospective cohort study.

IF 2.8 3区医学 Q2 ANESTHESIOLOGY

Journal of Anesthesia Pub Date : 2024-08-01 Epub Date: 2024-03-17 DOI:10.1007/s00540-024-03335-3

Hiroyuki Seki, Norifumi Kuratani, Toshiya Shiga, Yudai Iwasaki, Kanae Karita, Kazuki Yasuda, Natsuko Yamamoto, Yuko Nakanishi, Kenji Shigematsu, Kensuke Kobayashi, Junichi Saito, Ichiro Kondo, Nozomu Yaida, Hidenobu Watanabe, Midoriko Higashi, Tetsuro Shirasaka, Akira Doshu-Kajiura, Mitsutaka Edanaga, Satoshi Tanaka, Saori Ikumi, Shingo Ito, Masayuki Okada, Tomoko Yorozu

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引用次数: 0

Abstract

Purpose: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are commonly prescribed anti-diabetic medications with various beneficial effects; however, they have also been associated with ketoacidosis. The aim of this study was to determine the incidence of SGLT2i-associated perioperative ketoacidosis (SAPKA) in surgical patients.

Methods: We conducted a multicenter, prospective cohort study across 16 centers in Japan, enrolling surgical patients with diabetes who were prescribed SGLT2is between January 2021 and August 2022. Patients were monitored until the third postoperative day to screen for SAPKA, defined as urine ketone positivity with a blood pH of < 7.30 and HCO₃ level ≤ 18.0 mEq/L, excluding cases of respiratory acidosis.

Results: In total, 759 of the 762 evaluated patients were included in the final analysis. Among these, three patients (0.40%) had urine ketones with a blood pH of < 7.30; however, blood gas analysis revealed respiratory acidosis in all three, and none of them was considered to have SAPKA. The estimated incidence of SGLT2i-associated postoperative ketoacidosis was 0% (95% confidence interval, 0%-0.4%).

Conclusions: The observed incidence of SAPKA in our general surgical population was lower than expected. However, given that the study was observational in nature, interpretation of study results warrants careful considerations for biases.

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手术患者围术期酮症酸中毒与钠-葡萄糖共转运体-2 抑制剂相关的发生率：一项前瞻性队列研究。

目的：钠-葡萄糖共转运体 2 抑制剂（SGLT2is）是常用的处方抗糖尿病药物，具有多种益处，但也与酮症酸中毒有关。本研究旨在确定外科手术患者围术期酮症酸中毒（SAPKA）的发生率：我们在日本 16 个中心开展了一项多中心、前瞻性队列研究，招募了 2021 年 1 月至 2022 年 8 月期间接受 SGLT2is 治疗的外科糖尿病患者。患者在术后第三天前接受监测以筛查 SAPKA，SAPKA 的定义是尿酮阳性，血液 pH 值 3 级≤ 18.0 mEq/L，不包括呼吸性酸中毒病例：在 762 名接受评估的患者中，共有 759 人被纳入最终分析。其中，3 名患者（0.40%）在血液 pH 值为结论的情况下出现尿酮体：在我们的普通手术人群中观察到的 SAPKA 发生率低于预期。然而，由于该研究属于观察性质，因此在解释研究结果时应仔细考虑是否存在偏差。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Anesthesia 医学-麻醉学

CiteScore

5.30

自引率

7.10%

发文量

112

审稿时长

3-8 weeks

期刊介绍： The Journal of Anesthesia is the official journal of the Japanese Society of Anesthesiologists. This journal publishes original articles, review articles, special articles, clinical reports, short communications, letters to the editor, and book and multimedia reviews. The editors welcome the submission of manuscripts devoted to anesthesia and related topics from any country of the world. Membership in the Society is not a prerequisite. The Journal of Anesthesia (JA) welcomes case reports that show unique cases in perioperative medicine, intensive care, emergency medicine, and pain management.