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Diabetes, but Not Hypertension and Obesity, Is Associated with Postoperative Cognitive Dysfunction
背景与目的
接受⼿术的⽼年⼈有患POCD的⻛险。但是对于易患POCD的病⼈的⻛险因素知之甚少。我们的⽬的是评估术前暴露于糖尿病、⾼⾎压和肥胖相关的POCD的⻛险。
方 法
收集三个随机对照实验的原始数据(OCTOPUS, DECS, SuDoCo) 进⾏关于糖尿病、⾼⾎压和肥胖(BMI 30 kg/m2）以及BMI也作为POCD的危险因素使⽤多元逻辑回归模型进⾏⼆次分析。这3项研究综合进⾏⻛险评估。
结 果
分析共纳⼊1034名患者。DECS中患者POCD发⽣率为5.2%， Su- DoCo为9.4%， OCTOPUS中为32.1%。对年龄，性别，⼿术类型，随机化，肥胖，⾼⾎压的校正后，糖尿病与POCD增加1.84倍的发病⻛险密切相关 (OR 1.84; 95% CI 1.14, 2.97; p = 0.01)。充分校正后，肥胖，BMI，⾼⾎压和基础⾎压每⼀个都与POCD⽆关 (所有 p > 0.05). 。
结 论
术后认知功能障碍风险增加与糖尿病有关，而与高血压和肥胖无关。我们认为糖尿病状态对手术病人的风险评估可能会有帮助。
原始文献摘要
Background/Aims: Older people undergoing surgery are at risk of developing postoperative cognitive dysfunction (POCD), but little is known of risk factors predisposing patients to POCD. Our objective was to estimate the risk of POCD associated with exposure to preoperative diabetes, hypertension, and obesity.
Methods: Original data from 3 randomised controlled trials (OCTOPUS, DECS, SuDoCo) were obtained for secondary analysis on diabetes, hypertension, baseline blood pressure, obesity (BMI 30 kg/m2), and BMI as risk factors for POCD in multiple logistic regression models. Risk estimates were pooled across the 3 studies.
Results：Analyses totalled 1,034 patients. POCD occurred in 5.2% of patients in DECS, in 9.4% in Su- DoCo, and in 32.1% of patients in OCTOPUS. After adjustment for age, sex, surgery type, randomisation, obesity, and hypertension, diabetes was associated with a 1.84-fold increased risk of POCD (OR 1.84; 95% CI 1.14, 2.97; p = 0.01). Obesity, BMI, hypertension, and baseline blood pressure were each not associated with POCD in fully adjusted models (all p > 0.05).
Conclusion: Diabetes, but not obesity or hypertension, is associated with increased POCD risk. Consideration of diabetes status may be helpful for risk assessment of surgical patients.
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