Assessment of glucose concentrations before surgical intervention may help clinicians predict the risk for postoperative myocardial injury and mortality in patients with and without diabetes who are undergoing noncardiac surgery, according to a study published in The Lancet Diabetes & Endocrinology.
A total of 12 centers in 8 countries provided data from patients age ≥45 years who underwent noncardiac surgery (N=11,954). Clinical data, including medication use, preoperative glucose concentrations, and pre-existing comorbidities, were collected at the time of enrollment. The incidence of myocardial injury after noncardiac surgery (MINS) within 3 days following intervention comprised the primary outcome. Additionally, the secondary outcome included time to death from any cause within the first 30 days.
Approximately 7% (n=813) of patients experienced the primary outcome of MINS within 3 days of surgery. Of these patients, 2% (n=249) died by 30 days. Patients with diabetes (n=2809) were more likely to experience the primary outcome (odds ratio [OR], 1.98; 95% CI, 1.70-2.30; P <.0001) and were more likely to die (OR, 1.41; 95% CI, 1.08-1.86; P =.016) compared with patients without diabetes. In all patients, casual glucose concentrations were significantly associated with the primary outcome of MINS (adjusted OR, 1.06; 95% CI, 1.04-1.09; per 1 mmol/L increment in glucose; P =.0003), whereas casual glucose concentrations were more likely to predict death in patients without diabetes vs patients with diabetes (adjusted hazard ratio [HR], 1.13; 95% CI, 1.05-1.23; per mmol/L; P =.002).
Investigators also observed a significant progressive association between unadjusted fasting glucose concentrations and MINS, with an increased OR of MINS by 14% for each 1 mmol/L higher concentration of glucose (OR, 1.14; 95% CI, 1.08-1.20; P <.0001). This association was partly driven by glucose concentrations in patients with no diabetes history (Pinteraction=.025). Additionally, unadjusted fasting glucose concentrations were significantly associated with 30-day postoperative mortality, with the unadjusted HR in 30-day mortality increasing by 10% for every 1 mmol/L higher glucose concentration (HR, 1.10; 95% CI, 1.02-1.19; P =.013).
In patients without diabetes, a casual glucose concentration of >6.86 mmol/L (OR, 1.71; 95% CI, 1.36-2.15; P <.0001) and fasting glucose of >6.41 mmol/L (OR, 2.71; 95% CI, 1.85-3.98; P <.0001) was predictive for MINS. Additionally, only a casual glucose concentration of >7.92 mmol/L was predictive of MINS in patients with diabetes (OR, 1.47; 95% CI, 1.10-1.96; P =.0096).
The use of self-reported data to obtain patients’ diabetes history as well as the lack of other relevant confounders (eg, body mass index, smoking, and insulin resistance) likely limited the analysis.
These findings do hold potential clinical utility, according to the researchers, who suggested that clinicians “who consult on surgical patients can easily obtain glucose measurements in a matter of minutes and can now assess the incremental risk using empirically determined glucose thresholds, even after considering all the other known preoperative prognostic factors.”
Punthakee Z, Iglesias PP, Alonso-Coello P, et al. Association of preoperative glucose concentration with myocardial injury and death after non-cardiac surgery (GlucoVISION): a prospective cohort study [published online July 26, 2018]. Lancet Diabetes Endocrinol. doi:10.1016/S2213-8587(18)30205-5