Acute kidney disease and postoperative glycemia variability in patients undergoing cardiac surgery: A multicenter cohort analysis of 8,090 patients.

作者：Li-Hai Chen, Jie Sun, Si-Yu Kong, Qilian Tan, Xuesheng Liu, Yi Cheng, Fan Yang, Xuan Yin, Chen Zhang, Jia-Cong Liu, Lan-Xin Hu, Ya-Li Ge, Hong-Wei Shi, Jifang Zhou · 发表于：Journal of clinical anesthesia · 年份：2024 · DOI：10.1016/j.jclinane.2024.111706 · 被引用次数：2 · 研究领域：Medicine

BACKGROUND No previous research has specifically investigated the relationship between postoperative glycemic variability (GV) and acute kidney disease (AKD) in patients undergoing cardiac surgery. In this study, several methods of modelling postoperative GV were used to examine the association between GV and AKD risk and subtypes of AKD. METHODS We undertook a retrospective study involving a total of 8,090 adult patients from three academic medical centers in Eastern China who underwent cardiac surgery with cardiopulmonary bypass between 2015 and 2023. Seven-day postoperative GV was calculated using the standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE), average daily risk range (ADRR), and time out of target range (TOR). The primary focus was on the occurrence of AKD between 8 and 90 days post-surgery, which was further categorized into persistent AKD and delayed AKD depending on the acute kidney injury (AKI) status in the first 7 days. RESULTS During the 8-90 days postoperative period, AKD occurred in 522 out of 8,090 patients (6.5%). Seven-day postoperative GV was significantly and consistently higher in the AKD group (p<0.001 for each metric). After adjusting for relevant covariates, 7-day GV metrics were significantly associated with elevated AKD risk (standardized hazard ratio (SHR):1.20 (95% confidence interval (CI): (1.12 - 1.27) for SD; SHR: 1.30 (95% CI: 1.20 - 1.40) for TOR). GV was correlated with persistent AK...