接受手术治疗的肾下腹主动脉瘤患者中未确诊糖尿病的比例很高：挪威主动脉瘤和糖尿病多中心研究（ABANDIA）的结果

IF 8.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Diabetology Pub Date : 2024-09-09 DOI:10.1186/s12933-024-02421-w

J. Wesche, T. Bakken, M. Vetrhus, K. O. Hufthammer, L. Aa Nyroenning, H. Fagertun, I. Saethre, B. H. Wold, C. Lyng, E. M. Pettersen, I. S. Kjellsen, E. T. Gubberud, S. Kiil, H. Loose, M. T. Helgeland, M. E. Altreuther, E. Mattsson, T. Jonung, I. D. Hjellestad

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引用次数: 0

摘要

该研究旨在调查已知和未确诊糖尿病（DM）的总患病率，以及DM与择期、肾下、开放手术（OSR）或血管内（EVAR）腹主动脉瘤（AAA）修复术围手术期并发症的关联。在这项挪威前瞻性多中心研究中，877 名患者在 2017 年 11 月至 2020 年 12 月期间通过 HbA1c 测量接受了糖尿病术前筛查。糖尿病的定义是筛查出的 HbA1c ≥ 48 mmol/mol（6.5%）或既往诊断为糖尿病。采用调整和未调整的逻辑回归模型评估了糖尿病与院内并发症、住院时间和30天死亡率的关系。DM的总患病率为15%（95% CI为13%,17%），其中25%的DM病例（95% CI为18%,33%）在入院接受AAA手术时未被确诊。OSR与EVAR的比例为52%对48%，DM患者的分布情况相似，EVAR组与OSR组已知和未确诊的DM患病率没有差异。30天总死亡率为0.6%（5/877）。58名患者（7%）出现了66例器官相关并发症。DM与较高的院内器官相关并发症风险（OR 1.23，95% CI 0.57,2.39，p = 0.57）、手术相关并发症（OR 1.48，95% CI 0.79,2.63，p = 0.20）、30天死亡率（p = 0.09）或住院时间（HR 1.06，95% CI 0.88,1.28，p = 0.54）无明显统计学相关性。根据事后分析，与非糖尿病患者相比，新确诊的糖尿病患者（n = 32）更容易出现器官相关并发症（OR 4.92; 95% CI 1.53,14.3，p = 0.005）。所有DM病例中有25%在接受AAA手术时尚未确诊。根据事后分析，未确诊的DM似乎与AAA手术后器官相关并发症的风险增加有关。本研究建议对 AAA 患者进行 DM 普查，以减少未确诊的 DM 患者人数，并改善该人群的糖尿病前瞻性护理。事后分析的结果应在今后的研究中得到证实。

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High proportion of undiagnosed diabetes in patients surgically treated for infrarenal abdominal aortic aneurysm: findings from the multicentre Norwegian Aortic Aneurysm and Diabetes (ABANDIA) Study

The aim was to investigate the total prevalence of known and undiagnosed diabetes mellitus (DM), and the association of DM with perioperative complications following elective, infrarenal, open surgical (OSR) or endovascular (EVAR), Abdominal Aortic Aneurysm (AAA) repair. In this Norwegian prospective multicentre study, 877 patients underwent preoperative screening for DM by HbA1c measurements from November 2017 to December 2020. Diabetes was defined as screening detected HbA1c ≥ 48 mmol/mol (6.5%) or previously diagnosed diabetes. The association of DM with in-hospital complications, length of stay, and 30-day mortality rate were evaluated using adjusted and unadjusted logistic regression models. The total prevalence of DM was 15% (95% CI 13%,17%), of which 25% of the DM cases (95% CI 18%,33%) were undiagnosed upon admission for AAA surgery. The OSR to EVAR ratio was 52% versus 48%, with similar distribution among DM patients, and no differences in the prevalence of known and undiagnosed DM in the EVAR versus the OSR group. Total 30-day mortality rate was 0.6% (5/877). Sixty-six organ-related complications occurred in 58 (7%) of the patients. DM was not statistically significantly associated with a higher risk of in-hospital organ-related complications (OR 1.23, 95% CI 0.57,2.39, p = 0.57), procedure-related complications (OR 1.48, 95% CI 0.79,2.63, p = 0.20), 30-day mortality (p = 0.09) or length of stay (HR 1.06, 95% CI 0.88,1.28, p = 0.54). According to post-hoc-analyses, organ-related complications were more frequent in patients with newly diagnosed DM (n = 32) than in non-DM patients (OR 4.92; 95% CI 1.53,14.3, p = 0.005). Twenty-five percent of all DM cases were undiagnosed at the time of AAA surgery. Based on post-hoc analyses, undiagnosed DM seems to be associated with an increased risk of organ related complications following AAA surgery. This study suggests universal DM screening in AAA patients to reduce the number of DM patients being undiagnosed and to improve proactive diabetes care in this population. The results from post-hoc analyses should be confirmed in future studies.

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来源期刊

Cardiovascular Diabetology 医学-内分泌学与代谢

CiteScore

12.30

自引率

15.10%

发文量

240

审稿时长

1 months

期刊介绍： Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.