Diabetes is associated with risk of postoperative cognitive dysfunction: A meta-analysis
Diabetes is associated with risk of postoperative cognitive dysfunction: A meta-analysis
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DOI：
10.1002/dmrr.2884
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发表时间：
2017-07-01
影响因子：
8
通讯作者：
Pischon, T.
中科院分区：
文献类型：
--
作者：
Feinkohl, I.;Winterer, G.;Pischon, T.
背景：术后认知功能障碍（POCD）经常发生在手术后，尤其是老年人。糖尿病、慢性高血糖和低血糖史与认知功能障碍有关，但对它们在POCD中的作用知之甚少。在这里，我们估计他们的协会与风险的POCD的基础上发表的流行病学research.Methods：PubMed和科克伦数据库进行了搜索纵向研究的成年人接受手术与报告的协会的糖尿病状态，血糖水平，和/或低血糖的历史与风险的POCD的相对风险或比值比。荟萃分析的观察性流行病学研究（MOOSE）和系统评价和荟萃分析（PRISMA）guidelines were followed.Results：检索确定了246篇出版物，其中14篇符合纳入标准，共报告2642例患者（平均年龄64岁）。随访期为1天至5年。总体而言，糖尿病患者发生POCD的风险是无糖尿病患者的1.26倍（95%CI，1.12-1.42）。一项研究评估了糖尿病患者的血糖控制，并确定了较高的血红蛋白A1 c（HbA 1c）水平与较高的POCD风险相关（HbA 1c升高百分比的相对风险，2.0; 95% CI，1.4-2.6）。我们没有发现在非糖尿病范围内的血糖水平或低血糖作为POCD.Conclusion的潜在预测因素的研究：糖尿病患者似乎有更高的风险POCD相比，无糖尿病的人。在糖尿病患者中，POCD风险可能进一步增加，血糖控制较差，以HbA 1c较高为指标。非糖尿病人群中HbA 1c水平在POCD风险中的作用值得进一步研究。
Background: Postoperative cognitive dysfunction (POCD) occurs frequently after surgery, particularly among older people. Diabetes, chronic hyperglycemia, and a history of hypoglycemia are related to cognitive impairment, but little is known about their roles in POCD. Here, we estimated their associations with risk of POCD on the basis of published epidemiological research.Methods: The PubMed and Cochrane databases were searched for longitudinal studies of adults undergoing surgery with reporting of associations of diabetes status, glycemic levels, and/or a history of hypoglycemia with risk of POCD as relative risks or odds ratios. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.Results: The search identified 246 publications of which 14 met inclusion criteria, reporting on a total of 2642 patients (mean age 64 y). Follow-up periods spanned 1 day to 5 years. Overall, patients with diabetes had a 1.26-fold higher risk of POCD compared with diabetes-free patients (95% CI, 1.12-1.42). A single study assessed glycemic control in patients with diabetes and identified a higher hemoglobin A1c (HbA1c) level as associated with higher POCD risk (relative risk per percent higher HbA1c, 2.0; 95% CI, 1.4-2.6). We did not find studies on glycemic levels in the nondiabetic range or on hypoglycemia as potential predictors of POCD.Conclusion: Patients with diabetes appear to have a higher risk of POCD compared with diabetes-free persons. Among patients with diabetes, POCD risk may further increase with poorer glycemic control as indexed by higher HbA1c. The roles of HbA1c levels among nondiabetic persons in POCD risk warrant further research.