Association between stress hyperglycemia ratio and postoperative major adverse cardiovascular and cerebrovascular events in noncardiac surgeries: a large perioperative cohort study.

IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Diabetology Pub Date : 2024-11-02 DOI:10.1186/s12933-024-02467-w
Zhihan Lyu, Yunxi Ji, Yuhang Ji
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Abstract

Background: There has been a concerning rise in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) following noncardiac surgeries (NCS), significantly impacting surgical outcomes and patient prognosis. Glucose metabolism abnormalities induced by stress response under acute medical conditions may be a risk factor for postoperative MACCE. This study aims to explore the association between stress hyperglycemia ratio (SHR) and postoperative MACCE in patients undergoing general anesthesia for NCS.

Methods: There were 12,899 patients in this perioperative cohort study. The primary outcome was MACCE within 30 days postoperatively, defined as angina, acute myocardial infarction, cardiac arrest, arrhythmia, heart failure, stroke, or in-hospital all-cause mortality. Kaplan-Meier curves visualized the cumulative incidence of MACCE. Cox proportional hazard models were utilized to assess the association between the risk of MACCE and different SHR groups. Restricted cubic spline analyses were conducted to explore potential nonlinear relationships. Additionally, exploratory subgroup analyses and sensitivity analyses were performed.

Results: A total of 592 (4.59%) participants experienced MACCE within 30 days after surgery, and 1,045 (8.10%) within 90 days. After adjusting for confounding factors, compared to the SHR T2 group, the risk of MACCE within 30 days after surgery increased by 1.34 times (95% CI 1.08-1.66) in the T3 group and by 1.35 times (95% CI 1.08-1.68) in the T1 group respectively. In the non-diabetes group, the risk of MACCE within 30 days after surgery increased by 1.60 times (95% CI 1.21-2.12) in the T3 group and by 1.61 times (95% CI 1.21-2.14) in the T1 group respectively, while no statistically significant increase in risk was observed in the diabetes group. Similar results were observed within 90 days after surgery in the non-diabetes group. Additionally, a statistically significant U-shaped nonlinear relationship was observed in the non-diabetes group (30 days: P for nonlinear = 0.010; 90 days: P for nonlinear = 0.008).

Conclusion: In this large perioperative cohort study, we observed that both higher and lower SHR were associated with an increased risk of MACCE within 30 and 90 days after NCS, especially in patients without diabetes. These findings suggest that SHR potentially plays a key role in stratifying cardiovascular and cerebrovascular risk after NCS.

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非心脏手术中应激性高血糖比率与术后主要不良心脑血管事件之间的关系:一项大型围手术期队列研究。
背景:非心脏手术(NCS)后重大不良心脑血管事件(MACCE)的发生率呈上升趋势,严重影响手术效果和患者预后。急性医疗条件下应激反应引起的葡萄糖代谢异常可能是术后 MACCE 的风险因素。本研究旨在探讨接受全身麻醉的非手术治疗患者的应激性高血糖比率(SHR)与术后 MACCE 的关系:这项围手术期队列研究共有 12,899 名患者参与。主要结果是术后 30 天内的 MACCE,定义为心绞痛、急性心肌梗死、心脏骤停、心律失常、心力衰竭、中风或院内全因死亡。Kaplan-Meier曲线显示了MACCE的累积发生率。利用 Cox 比例危险模型评估 MACCE 风险与不同 SHR 组之间的关联。为探索潜在的非线性关系,还进行了限制性三次样条分析。此外,还进行了探索性亚组分析和敏感性分析:共有592人(4.59%)在术后30天内出现MACCE,1,045人(8.10%)在术后90天内出现MACCE。调整混杂因素后,与 SHR T2 组相比,T3 组和 T1 组术后 30 天内发生 MACCE 的风险分别增加了 1.34 倍(95% CI 1.08-1.66)和 1.35 倍(95% CI 1.08-1.68)。在非糖尿病组中,术后 30 天内发生 MACCE 的风险在 T3 组和 T1 组分别增加了 1.60 倍(95% CI 1.21-2.12)和 1.61 倍(95% CI 1.21-2.14),而在糖尿病组中未观察到有统计学意义的风险增加。非糖尿病组在术后 90 天内也观察到类似的结果。此外,在非糖尿病组中观察到具有统计学意义的 U 型非线性关系(30 天:非线性 P = 0.010;90 天:非线性 P = 0.008):在这项大型围手术期队列研究中,我们观察到较高和较低的 SHR 均与 NCS 后 30 天和 90 天内 MACCE 风险的增加有关,尤其是在非糖尿病患者中。这些研究结果表明,SHR 在非手术治疗后的心脑血管风险分层中可能起着关键作用。
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来源期刊
Cardiovascular Diabetology
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.
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