Diabetes Mellitus and Increased Postoperative Risk of Acute Renal Failure After Hepatectomy for Hepatocellular Carcinoma: A Nationwide Population-Based Study
Diabetes Mellitus and Increased Postoperative Risk of Acute Renal Failure After Hepatectomy for Hepatocellular Carcinoma: A Nationwide Population-Based Study
复制标题
肝细胞癌肝切除术后糖尿病和急性肾衰竭术后风险增加：一项全国范围的人群研究
作者：
Ming;Cheng;Shih‐Ni Chang;Po‐Huang Lee;C. Kao
本研究旨在确定糖尿病(DM)对肝细胞癌(HCC)肝切除术患者手术死亡率和发病率的影响。方法我们选择了2000-2010年间接受肝切除术的2962例DM患者。非糖尿病对照组包括2962名患者，他们在同一时期也接受了肝切除术。结果DM组和非DM组患者术前并存疾病的发生率基本相当，但接受大范围肝切除的患者比例(DM组为18.1%，非DM组为20.4%；P=0.02)。调整后，DM组患者术后30d死亡的风险比(HR)为1.17[95%可信区间(CI)0.75~1.84]。与非糖尿病组相比，糖尿病组术后败血症(调整风险比1.45；95%可信区间1.06-2.00)和急性肾功能衰竭(调整风险比1.70；95%可信区间1.01-2.84)的风险显著增加，但这一较高风险与肺炎、中风和心肌梗死等其他主要疾病的风险增加无关。进一步分析表明，糖尿病患者行肝大部切除术(肝叶切除术)会增加败血症和急性肾功能衰竭的风险。在多元回归模型中，术前糖尿病相关并发症与术后30天的死亡率无显著相关性。结论肝细胞癌肝切除术后，糖尿病与败血症和急性肾功能衰竭的风险显著相关，但与其他主要并发症或死亡率无关。
BackgroundThis study aimed to determine the effects of diabetes mellitus (DM) on the risk of surgical mortality and morbidity in patients undergoing hepatectomy for hepatocellular carcinoma (HCC).MethodsWe identified 2,962 DM patients who underwent a hepatectomy for HCC from 2000 to 2010. The non-DM control cohort consisted of 2,962 patients who also received a hepatectomy during the same period. Age, sex, comorbidities, and year of admission were all matched between the 2 cohorts.ResultsThe prevalence of preoperative coexisting medical conditions was comparable between the DM and non-DM cohorts, except the percentage of patients undergoing major hepatectomy (lobectomy; 18.1 % in the DM cohort vs. 20.4 % in the non-DM cohort; p = 0.02).The hazard ratio (HR) of 30-day postoperative mortality in the DM patients after hepatectomy was 1.17 [95 % confidence interval (CI) 0.75–1.84] after adjustment. The DM cohort exhibited a significantly higher risk of postoperative septicemia (adjusted hazard ratio, 1.45; 95 % CI 1.06–2.00) and acute renal failure (adjusted hazard ratio, 1.70; 95 % CI 1.01–2.84) compared with that of the non-DM cohort, but this higher risk was not associated with the increased risk of other major morbidities, including pneumonia, stroke, and myocardial infarction. Further analysis showed that major hepatectomy (lobectomy) in DM patients carried higher risks of septicemia and acute renal failure. In multiple regression models, preoperative diabetes-related comorbidities were not significantly associated with 30-day postoperative mortality.ConclusionsDM is associated with a significantly high risk of septicemia and acute renal failure, but not with other major complications or mortality, after hepatectomy for HCC.