Postoperative dysglycemia in elective non-diabetic surgical patients: a prospective observational study.

Survey of Anesthesiology Pub Date : 2017-04-01 DOI:10.1097/01.sa.0000516022.94902.80

Michael Hang Yang, M. Jaeger, M. Baxter, E. Vandenkerkhof, J. V. van Vlymen

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引用次数: 5

Abstract

PURPOSE Elevated glycosylated hemoglobin (HbA1c) is often found in surgical patients with no history of diabetes. The purpose of this prospective observational study was to determine if elevated preoperative HbA1c is associated with postoperative hyperglycemia in non-diabetic surgical patients and to identify predictors of elevated HbA1c. METHODS This study included 257 non-diabetic adults scheduled for inpatient surgery. Preoperatively, capillary blood glucose (CBG) and HbA1c were measured and patients completed the Canadian Diabetes Risk Questionnaire (CANRISK). Capillary blood glucose was measured for two days or until hospital discharge at the following time points: postoperatively, before all meals, and at 22:00 hr. The mean CBG and incidence of hyperglycemia were compared between HbA1c levels: Group I < 6.0%, Group II 6.0-6.4%, and Group III ≥ 6.5%. RESULTS The mean postoperative glucose levels at all time points were significantly higher in Group III compared with Groups I and II (P < 0.01). At least one episode of hyperglycemia (CBG ≥ 10.0 mMol·L-1) occurred in 61% (11/18) of patients in Group III vs 11% (23/209) of patients in Group I (relative risk, 5.55; 95% confidence interval [CI], 3.26 to 9.47; P < 0.001). Elevated glycosylated hemoglobin ≥ 6.0% was found in 31% (33/107) of those with a high CANRISK score. The best predictors of postoperative hyperglycemia were preoperative CBG > 6.9 mMol·L-1 [diagnostic odds ratio (OR) (reference < 6.0 mMol·L-1), 4.16; 95% CI, 1.57 to 10.98; P = 0.004], HbA1c ≥ 6.0% [OR (reference < 6.0%), 3.00; 95% CI, 1.39 to 6.49; P = 0.005], and HbA1c ≥ 6.5% [OR (reference < 6.5%), 13.45; 95% CI, 4.78 to 37.84; P <0.001]. CONCLUSIONS Elevated HbA1c is associated with higher mean postoperative glucose levels in patients with no diabetic history. The CANRISK score is a strong predictor of elevated HbA1c, while CBG and HbA1c are both predictors of postoperative hyperglycemia.

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选择性非糖尿病手术患者术后血糖异常:一项前瞻性观察研究。

目的:糖化血红蛋白(HbA1c)升高常见于无糖尿病史的手术患者。这项前瞻性观察性研究的目的是确定非糖尿病手术患者术前HbA1c升高是否与术后高血糖相关，并确定HbA1c升高的预测因素。方法本研究纳入257例计划住院手术的非糖尿病成年人。术前测量毛细血管血糖(CBG)和糖化血红蛋白(HbA1c)，并完成加拿大糖尿病风险问卷(CANRISK)。在以下时间点测量毛细血管血糖2天或直到出院:术后、所有餐前和22:00小时。比较各组HbA1c水平的平均CBG和高血糖发生率:I组< 6.0%，II组6.0 ~ 6.4%，III组≥6.5%。结果III组术后各时间点平均血糖水平均显著高于I、II组(P < 0.01)。61%(11/18)的III组患者至少发生一次高血糖(CBG≥10.0 mMol·L-1)，而11%(23/209)的I组患者(相对危险度，5.55;95%置信区间[CI]， 3.26 ~ 9.47;P < 0.001)。在CANRISK评分较高的患者中，有31%(33/107)的糖化血红蛋白升高≥6.0%。术后高血糖的最佳预测指标为术前CBG > 6.9 mMol·L-1[诊断优势比(OR)(参考< 6.0 mMol·L-1)， 4.16;95% CI, 1.57 ~ 10.98;P = 0.004]， HbA1c≥6.0% [OR(参考文献< 6.0%)，3.00;95% CI, 1.39 ~ 6.49;P = 0.005]， HbA1c≥6.5% [OR (reference < 6.5%)， 13.45;95% CI, 4.78 ~ 37.84;P < 0.001)。结论:无糖尿病史患者HbA1c升高与术后平均血糖升高相关。CANRISK评分是HbA1c升高的有力预测指标，而CBG和HbA1c都是术后高血糖的预测指标。

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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Survey of Anesthesiology

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