心血管-肾脏-代谢综合征：与大型非心脏手术后不良事件的关联。

Cardiovascular-Kidney-Metabolic Syndrome: Association with Adverse Events After Major Noncardiac Surgery.

机构信息

From the Department of Anesthesiology, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.

CARID (Cardiovascular Research Institute Duesseldorf), University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.

出版信息

Anesth Analg. 2024 Sep 1;139(3):679-681. doi: 10.1213/ANE.0000000000006975. Epub 2024 Aug 16.

DOI:10.1213/ANE.0000000000006975

PMID:39159243

Abstract

BACKGROUND

The American Heart Association (AHA) recently defined the cardiovascular-kidney-metabolic syndrome (CKM) as a new entity to address the complex interactions between heart, kidneys, and metabolism. The aim of this study was to assess the outcome impact of CKM syndrome in patients undergoing noncardiac surgery.

METHODS

This is a secondary analysis of a prospective international cohort study including patients aged ≥45 years with increased cardiovascular risk undergoing noncardiac surgery. Main exposure was CKM syndrome according to the AHA definition. The primary end point was a composite of major adverse cardiovascular events (MACE) 30 days after surgery. Secondary end points included all-cause mortality and non-MACE complications (Clavien-Dindo class ≥3).

RESULTS

This analysis included 14,634 patients (60.8% male, mean age = 72±8 years). MACE occurred in 308 patients (2.1%), and 335 patients (2.3%) died. MACE incidence by CKM stage was as follows: CKM 0: 5/367 = 1.4% (95% confidence interval [CI], 0.4%-3.2%); CKM 1: 3/367 = 0.8% (95% CI, 0.2%-2.4%); CKM 2: 102/7440 = 1.4% (95% CI, 1.1%-1.7%); CKM 3: 27/953 = 2.8% (95% CI, 1.9%-4.1%); CKM 4a: 164/5357 = 3.1% (95% CI, 2.6%-3.6%); CKM 4b: 7/150 = 4.7% (95% CI, 1.9%-9.4%). In multivariate logistic regression, CKM stage ≥3 was independently associated with MACE, mortality, and non-MACE complications, respectively (MACE: OR 2.26 [95% CI, 1.78-2.87]; mortality: OR 1.42 [95% CI: 1.13 -1.78]; non-MACE complications: OR 1.11 [95% CI: 1.03-1.20]).

CONCLUSION

The newly defined CKM syndrome is associated with increased morbidity and mortality after non-cardiac surgery. Thus, cardiovascular, renal, and metabolic disorders should be regarded in mutual context in this setting.

摘要

背景

美国心脏协会（AHA）最近将心血管-肾脏-代谢综合征（CKM）定义为一种新实体，以解决心脏、肾脏和代谢之间的复杂相互作用。本研究旨在评估 CKM 综合征在接受非心脏手术的患者中的预后影响。

方法

这是一项对包括年龄≥45 岁、心血管风险增加的接受非心脏手术患者的前瞻性国际队列研究的二次分析。主要暴露为 AHA 定义的 CKM 综合征。主要终点是手术后 30 天的主要不良心血管事件（MACE）复合终点。次要终点包括全因死亡率和非 MACE 并发症（Clavien-Dindo 分级≥3）。

结果

本分析纳入了 14634 例患者（60.8%为男性，平均年龄为 72±8 岁）。308 例患者（2.1%）发生 MACE，335 例患者（2.3%）死亡。根据 CKM 分期的 MACE 发生率如下：CKM 0：367 例中有 5 例（5/367=1.4%，95%置信区间[CI]，0.4%-3.2%）；CKM 1：367 例中有 3 例（3/367=0.8%，95%CI，0.2%-2.4%）；CKM 2：7440 例中有 102 例（102/7440=1.4%，95%CI，1.1%-1.7%）；CKM 3：953 例中有 27 例（27/953=2.8%，95%CI，1.9%-4.1%）；CKM 4a：5357 例中有 164 例（164/5357=3.1%，95%CI，2.6%-3.6%）；CKM 4b：150 例中有 7 例（7/150=4.7%，95%CI，1.9%-9.4%）。多变量逻辑回归显示，CKM 分期≥3 与 MACE、死亡率和非 MACE 并发症独立相关（MACE：OR 2.26[95%CI，1.78-2.87]；死亡率：OR 1.42[95%CI：1.13-1.78]；非 MACE 并发症：OR 1.11[95%CI：1.03-1.20]）。