心脏手术患者的急性肾病和术后血糖变化：对 8090 名患者进行的多中心队列分析

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2024-11-26 DOI:10.1016/j.jclinane.2024.111706

Lihai Chen MD, PhD , Jie Sun MD, PhD , Siyu Kong BS , Qilian Tan MD , Xuesheng Liu MD, PhD , Yi Cheng BS , Fan Yang BS , Xuan Yin BS , Chen Zhang BS , Jiacong Liu BS , Lanxin Hu BS , Yali Ge MD, PhD , Hongwei Shi MD, PhD , Jifang Zhou MD, PhD, MPH

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引用次数: 0

摘要

背景以前没有研究专门探讨过心脏手术患者术后血糖变异性（GV）与急性肾病（AKD）之间的关系。本研究采用多种方法对术后血糖变异性进行建模，以探讨血糖变异性与急性肾脏病风险及急性肾脏病亚型之间的关系。方法我们开展了一项回顾性研究，涉及华东地区三个学术医疗中心在 2015 年至 2023 年期间接受心肺旁路心脏手术的 8090 名成年患者。采用标准差（SD）、变异系数（CV）、血糖偏移平均幅度（MAGE）、日平均风险范围（ADRR）和超出目标范围时间（TOR）计算术后七天血糖值。主要关注点是术后 8 至 90 天内 AKD 的发生情况，并根据术后前 7 天的急性肾损伤（AKI）状况将其进一步分为持续性 AKD 和延迟性 AKD。结果在术后 8 至 90 天内，8090 名患者中有 522 人（6.5%）发生了 AKD。AKD 组的术后 7 天 GV 显著且持续较高（各项指标均为 p<0.001）。调整相关协变量后，7 天 GV 指标与 AKD 风险升高显著相关（标准化危险比 (SHR)：1.20（95% 置信区间 (CI)：SD 为 (1.12 - 1.27)；SHR：1.30（95% 置信区间 (CI)：TOR 为 1.20 - 1.40）。GV 与持续性 AKD 相关，而 GV 与延迟性 AKD 之间没有统计学意义上的显著关联。我们的研究强调了术后 GV 与 AKD 风险增加之间的关联，并确定了接受心脏手术的成人的特定 GV 临界值。

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Acute kidney disease and postoperative glycemia variability in patients undergoing cardiac surgery: A multicenter cohort analysis of 8,090 patients

Background

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.

Methods

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.

Results

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.

Conclusions

Our study highlights the association between postoperative GV and increased AKD risk, and identifies specific GV thresholds in adults undergoing cardiac surgery.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.