Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942007000600006
Brazilian Journal of Anesthesiology
Scientific Article

Associação entre glicemia de jejum e morbimortalidade perioperatória: estudo retrospectivo em pacientes idosos cirúrgicos

Association between fasting blood glucose levels and perioperative morbimortality: retrospective study in surgical elderly patients

Arthur Vitor Rosenti Segurado; Flavia Salles Souza Pinotti Pedro; Judymara Lauzi Gozzani; Lígia Andrade da Silva Telles Mathias

http://dx.doi.org/10.1590/S0034-70942007000600006 Braz J Anesthesiol, vol.57, n6, p.639-648, 2007
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Resumo

JUSTIFICATIVA E OBJETIVOS: As relações entre valores alterados de glicemia e complicações perioperatórias na população de idosos submetidos a procedimentos cirúrgicos ainda não são conhecidas. O objetivo deste estudo foi avaliar a associação entre glicemia de jejum e morbimortalidade perioperatória em pacientes cirúrgicos idosos. MÉTODO: Foram analisados os prontuários de pacientes acima de 60 anos submetidos a diversos procedimentos cirúrgicos num período de seis meses, divididos de acordo com os valores de glicemia de jejum nos grupos: < 100 mg.dL-1, entre 100 e 125 mg.dL-1 e > 126 mg.dL-1. Foram analisados quanto à idade, estado físico (ASA), história prévia de diabete melito (DM) e tratamento e risco cardíaco perioperatório cirurgia-específico. Por meio de análise univariada e de um modelo de regressão logística multivariada, foi avaliada a relação entre os desfechos (freqüência de complicações pós-operatórias [CPO] e óbitos) e as variáveis: glicemia de jejum, história prévia de DM, estado físico (ASA) e risco cardíaco. RESULTADOS: Houve associação estatística apenas entre os grupos glicêmicos e as variáveis estado físico e história prévia de DM. Todas as variáveis estudadas revelaram associação estatística em relação à maior freqüência de CPO e óbitos, exceto a variável presença de história prévia de DM, que não apresentou relação com óbitos. No modelo de regressão logística multivariada, houve associação entre as variáveis risco cardíaco e glicemia em função da ocorrência de CPO, enquanto apenas as variáveis estado físico e risco cardíaco revelaram associação estatística em função da ocorrência de óbitos. CONCLUSÕES: Este estudo retrospectivo mostrou que para a população de pacientes idosos estudada houve associação significativa entre glicemias acima de 100 mg.dL-1 e morbimortalidade perioperatória.

Palavras-chave

CIRURGIA, Geriátrica, COMPLICAÇÕES, DOENÇAS, EXAMES COMPLEMENTARES

Abstract

BACKGROUND AND OBJECTIVES: The relationship between altered blood glucose levels and perioperative complications in elderly patients undergoing surgeries are not known. The objective of this study was to evaluate the association between fasting blood glucose levels and perioperative morbimortality in elderly surgical patients. METHODS: Medical records of patients older than 60 years undergoing several surgical procedures during a 6-month period were analyzed and divided, according to fasting blood glucose levels, in three groups: < 100 mg.dL-1, between 100 and 125 mg.dL-1, and > 126 mg.dL-1. Age, physical status (ASA), history of diabetes mellitus (DM), and treatment and perioperative surgery-specific cardiologic risk were analyzed. Using univariate analysis and a model of multivariate logistic regression, the relationship among the outcome (frequency of postoperative complications [POC] and death) and the following variables: fasting blood glucose, history of DM, physical status (ASA), and cardiac risk, was evaluated. RESULTS: A statistical association was demonstrated only among the three groups and physical status and history of DM. All parameters studied demonstrated a statistical relationship regarding the higher frequency of POC and death, except for the parameter history of DM, which did not demonstrate any relationship with deaths. In the multivariate logistic regression model, there was an association between cardiac risk and blood glucose levels with POC, while only physical status and cardiac risk demonstrated a statistical association with death. CONCLUSIONS: This retrospective study demonstrated a significant association among blood glucose levels above 100 mg.dL-1 and postoperative morbimortality in the elderly.

Keywords

COMPLEMENTARY LABORATORY TESTS, COMPLICATIONS, DISEASES, SURGERY, Geriatric

Referências

Dzankic KS, Pastor D, Gonzalez C. The prevalence and predictive value of abnormal preoperative laboratory tests in elderly surgical patients. Anesth Analg. 2001;93:301-308.

Jin F, Chung F. Minimizing perioperative adverse effects in the elderly. Br J Anaesth. 2001;87:608-624.

Cook DJ, Rooke GA. Priorities in perioperative geriatrics. Anesth Analg. 2003;93:1823-1836.

Brown DR. Perioperative management of the diabetic patient. . 2005.

Weir CJ, Murray GD, Dyker AG. Is hyperglycaemia an independent predictor of poor outcome after acute stroke?: Results of a long-term follow up study. BMJ. 1997;314:1303-1306.

Demchuck AM, Morgenstern LB, Krieger DW. Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke. Stroke. 1999;30:34-39.

McCowan KC, Malhoota A, Bistrian BR. Endocrine and metabolic dysfunction syndromes in the critically ill. Crit Care Clin. 2001;17:107-124.

Stranders I, Diamant M, Van Gelder RE. Admission blood glucose level as risk indicator of death after myocardial infarction in patients with and without diabetes mellitus. Arch Intern Med. 2004;164:982-988.

Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc. 2003;78:1471-1478.

Furnary AP, Zerr KJ, Grunkemeier GL. Continuous intravenous insulin infusions reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg. 2000;69:667-668.

Van den Berghe G, Wouters P, Weekers F. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359-1367.

Finney SJ, Zekvaeld C, Elia A. Glucose control and mortality in critically ill patients. JAMA. 2003;290:2041-2047.

Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003;26:3329-3330.

Almeida Filho N, Rouquayol MZ. Desenhos de Pesquisa em Epidemiologia. Introdução à Epidemiologia. 2002:69-214.

Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. .

Oswald GA, Smith CC, Betteridge DJ. Determinants and importance of stress hyperglycaemia in non-diabetic patients with myocardial infarction. BMJ. 1986;293:917-922.

Tenerz A, Lonnberg I, Berne C. Myocardial infarction and prevalence of diabetes mellitus: is increased casual blood glucose at admission a reliable criterion for the diagnosis of diabetes?. Eur Heart J. 2001;22:1102-1110.

Bolk J, Van der Ploeg TJ, Cornel JH. Impaired glucose metabolism predicts mortality after a myocardial infarction. Int J Cardiol. 2001;79:207-214.

Coursin DB, Connery LE, Ketzler JT. Perioperative diabetic and hyperglycemic management issues. Crit Care Med. 2004;32(^s4):116-125.

Detsky AS, Abrams HB, Forbath N. Cardiac assessment for patients undergoing noncardiac surgery: a multifactorial clinical risk index. Arch Intern Med. 1986;146:2131-2134.

Pedersen T, Eliasen K, Henriksen E. A prospective study of mortality associated with anaesthesia and surgery: risk indicators of mortality in hospital. Acta Anaesthesiol Scand. 1990;34:176-182.

Arvidsson S, Ouchterlony J, Sjostedt L. Predicting postoperative adverse events: clinical efficiency of four general classification systems the project perioperative risk. Acta Anaesthesiol Scand. 1996;40:783-91.

Liu L, Leung J. Predicting adverse postoperative outcomes in patients aged 80 years or older. J Am Geriatr Soc. 2000;48:405-412.

Eagle KA, Berger PB, Calkins H. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesth Analg. 2002;94:1052-1064.

Norhammar AM, Rydén L, Malmberg K. Admission plasma glucose: independent risk factor for long term prognosis after myocardial infarction even in nondiabetic patients. Diabetes Care. 1999;22:1827-1831.

Capes SE, Hunt D, Malmberg K. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet North Am Ed. 2000;355:773-778.

Norhammar A, Tenerz A, Nilsson G. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet. 2002;359:2140-2145.

Umpierrez GE, Isaacs SD, Bazargan N. Hyperglycemia: an independent marker of in-hospital mortality in patient with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87:978-982.

Gerstein H. Is glucose a continuous risk factor for cardiovascular mortality?. Diabetes Care. 1999;22:659-660.

Fuller JH, Shipley MJ, Rose G. Coronary-heart-disease risk and impaired glucose tolerance: the Whitehall study. Lancet. 1980;8183:1373-1376.

Bjornholt JV, Erikssen G, Aaser E. Fasting blood glucose: an underestimated risk factor for cardiovascular death: results from a 22-year follow up of healthy non-diabetic men. Diabetes Care. 1999;22:45-49.

Coutinho M, Gerstein HC, Wang Y. The relationship between glucose and incident cardiovascular events: a metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care. 1999;22:233-240.

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