Type 2 Diabetes Increases Risk of Unfavorable Survival Outcome for Postoperative Ischemic Stroke in Patients Who Underwent Non-cardiac Surgery: A Retrospective Cohort Study.
Type 2 Diabetes Increases Risk of Unfavorable Survival Outcome for Postoperative Ischemic Stroke in Patients Who Underwent Non-cardiac Surgery: A Retrospective Cohort Study.
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2 型糖尿病会增加接受非心脏手术的患者术后缺血性中风的不利生存结果的风险：一项回顾性队列研究
DOI：
10.3389/fnagi.2021.810050
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发表时间：
2021
影响因子：
4.8
通讯作者：
Mi W
中科院分区：
文献类型：
--
作者：
Zhang F;Ma Y;Yu Y;Sun M;Li H;Lou J;Cao J;Liu Y;Niu M;Wang L;Mi W
目的：糖尿病（DM）与普通人群的不良结局密切相关。我们的目的是研究2型糖尿病与非心脏手术患者术后缺血性卒中长期生存结局之间的关系。研究设计和方法：这是一项对2008年1月至2019年8月期间发生术后缺血性卒中的非心脏手术患者进行的回顾性队列研究。术后缺血性脑卒中患者中纳入糖尿病个体与糖尿病组。关注的结局是长期总生存期（OS）。我们进行了倾向评分匹配（PSM）和逆概率治疗加权（IPTW），以调整组间的基线特征差异。采用逐步选择的多因素考克斯回归分析计算OS和2型DM的校正风险比（HR）。结果：在中位随访46.2个月[四分位距（IQR），21.1，84.2]期间，408例患者中有200例（49.0%）死亡。合并糖尿病的术后缺血性卒中患者的3年、5年和10年OS率显著低于未合并糖尿病的患者（3年OS：52.2 vs. 69.5%，p <0.001; 5年OS：41.6 vs. 62.4%，p <0.001; 10年OS：37.2 vs. 56.6%，p <0.001）。使用PSM或IPTW后，所有协变量均在组间平衡。在主要分析中，2型糖尿病术后缺血性卒中患者的OS缩短（HR：1.947; 95% CI：1.397 - 2.713; p <0.001），PSM分析（HR：2.190; 95%CI：1.354 - 3.540; p = 0.001）和IPTW分析（HR：2.551; 95%CI：1.769 - 3.679; p <0.001）。结论：在接受非心脏手术的患者中，2型糖尿病与术后缺血性卒中的不利生存结局相关。当术后缺血性卒中与2型糖尿病同时发生时，潜在的协同作用将使死亡风险成倍增加。进一步的研究，以评估2型糖尿病对长期生存的不良影响可能是必要的。
Objective: Diabetes mellitus (DM) has been critically associated with unfavorable outcomes in the general population. We aimed to investigate the association between type 2 DM and long-term survival outcomes for postoperative ischemic stroke in patients who underwent non-cardiac surgery. Research Design and Methods: This was a retrospective cohort study of patients with non-cardiac surgery who had suffered from postoperative ischemic stroke between January 2008 and August 2019. Diabetic individuals were included in postoperative ischemic stroke patients with the DM group. The outcome of interest was long-term overall survival (OS). We conducted propensity score matching (PSM) and inverse probability treatment weighting (IPTW) to adjust for baseline characteristic differences between groups. Multivariate Cox regression analysis with stepwise selection was used to calculate the adjusted hazard ratio (HR) of OS and type 2 DM. Results: During a median follow-up of 46.2 month [interquartile range (IQR), 21.1, 84.2], 200 of 408 patients (49.0%) died. The OS rates at 3, 5, and 10 years were significantly lower for postoperative ischemic stroke patients with DM than those without DM (3 years OS: 52.2 vs. 69.5%, p < 0.001; 5 years OS: 41.6 vs. 62.4%, p < 0.001; 10 years OS: 37.2 vs. 56.6%, p < 0.001). All covariates were between-group balanced after using PSM or IPTW. The postoperative ischemic stroke patients with type 2 DM had a shortened OS in primary analysis (HR: 1.947; 95% CI: 1.397–2.713; p < 0.001), PSM analysis (HR: 2.190; 95% CI: 1.354–3.540; p = 0.001), and IPTW analysis (HR: 2.551; 95% CI: 1.769–3.679; p < 0.001). Conclusion: Type 2 DM was associated with an unfavorable survival outcome for postoperative ischemic stroke in patients who underwent non-cardiac surgery. When postoperative ischemic stroke co-occurred with type 2 DM, the potential synergies would have multiplicative mortality risk. Further research to assess the adverse effects of type 2 DM on long-term survival may be warranted.
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