Effect of A1C and Glucose on Postoperative Mortality in Noncardiac and Cardiac Surgeries
Effect of A1C and Glucose on Postoperative Mortality in Noncardiac and Cardiac Surgeries
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DOI：
10.2337/dc17-2232
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发表时间：
2018-04-01
期刊：
影响因子：
16.2
通讯作者：
Dunson, David B.
中科院分区：
文献类型：
--
作者：
van den Boom, Willem;Schroeder, Rebecca A.;Dunson, David B.
血红蛋白A（1c）（A1 C）用于评估择期手术的患者，因为高血糖会增加不良事件的风险。然而，A1 C、血糖和手术结果的相互作用仍然不清楚，通常只同时考虑这三个因素中的两个。研究设计和方法回顾性分析杜克大学卫生系统内431，480例手术，确定术前A1 C与围手术期血糖的相关性（术后前3天的平均值）和30天死亡率在6,684例非心脏手术和6,393例心脏手术中进行A1 C和葡萄糖测量。一个广义的加性模型，使非线性关系。TSA 1C和葡萄糖强烈相关。非心源性病例的血糖和死亡率呈正相关：平均血糖100 mg/dL时死亡率为1.0%，平均血糖200 mg/dL时死亡率为1.6%。对于心脏手术，葡萄糖与死亡率之间存在显著的U形关系，范围从100 mg/dL时的4.5%到140 mg/dL时的1.5%的最低点，并再次上升至200 mg/dL时的6.9%。A1 C和30天的死亡率不相关时，控制血糖在非心脏或心脏procedure.CONCLUSIONSAlthough A1 C是正相关的围手术期血糖，它是不相关的增加30天的死亡率后，控制血糖。围手术期血糖预测30天死亡率，在非心脏手术中呈线性，在心脏手术中呈非线性。这证实了围手术期血糖控制与手术结果有关，但A1 C反映了先前的糖尿病，是一个不太有用的预测因子。
OBJECTIVEHemoglobin A(1c) (A1C) is used in assessment of patients for elective surgeries because hyperglycemia increases risk of adverse events. However, the interplay of A1C, glucose, and surgical outcomes remains unclarified, with often only two of these three factors considered simultaneously. We assessed the association of preoperative A1C with perioperative glucose control and their relationship with 30-day mortality.RESEARCH DESIGN AND METHODSRetrospective analysis on 431,480 surgeries within the Duke University Health System determined the association of preoperative A1C with perioperative glucose (averaged over the first 3 postoperative days) and 30-day mortality among 6,684 noncardiac and 6,393 cardiac surgeries with A1C and glucose measurements. A generalized additive model was used, enabling nonlinear relationships.RESULTSA1C and glucose were strongly associated. Glucose and mortality were positively associated for noncardiac cases: 1.0% mortality at mean glucose of 100 mg/dL and 1.6% at mean glucose of 200 mg/dL. For cardiac procedures, there was a striking U-shaped relationship between glucose and mortality, ranging from 4.5% at 100 mg/dL to a nadir of 1.5% at 140 mg/dL and rising again to 6.9% at 200 mg/dL. A1C and 30-day mortality were not associated when controlling for glucose in noncardiac or cardiac procedures.CONCLUSIONSAlthough A1C is positively associated with perioperative glucose, it is not associated with increased 30-day mortality after controlling for glucose. Perioperative glucose predicts 30-day mortality, linearly in noncardiac and nonlinearly in cardiac procedures. This confirms that perioperative glucose control is related to surgical outcomes but that A1C, reflecting antecedent glycemia, is a less useful predictor.