Severe Intraoperative Hyperglycemia Is Independently Associated With Surgical Site Infection After Liver Transplantation

被引:122
作者
Park, Chulsoo [1 ,2 ]
Hsu, Chehao [3 ]
Neelakanta, Gundappa [1 ]
Nourmand, Hamid [1 ]
Braunfeld, Michelle [1 ]
Wray, Christopher [1 ]
Steadman, Randolph H. [1 ]
Hu, Ke-Qin [4 ]
Cheng, Ronald T. [1 ]
Xia, Victor W. [1 ]
机构
[1] Univ Calif Los Angeles, David Geffen Sch Med, Dept Anesthesiol, Ronald Reagan UCLA Med Ctr, Los Angeles, CA 90095 USA
[2] Catholic Univ Med, Dept Anesthesiol, Seoul, South Korea
[3] Natl Def Med Ctr, Dept Anesthesiol, Tri Serv Gen Hosp, Taipei, Taiwan
[4] Univ Calif Irvine, Irvine Med Ctr, Div Gastroenterol, Orange, CA 92668 USA
关键词
Liver transplantation; Hyperglycemia; Outcome; Surgical site infection; Risk factors; BLOOD-GLUCOSE CONTROL; INTENSIVE INSULIN THERAPY; CARDIAC-SURGERY; DIABETES-MELLITUS; ILL PATIENTS; MORTALITY; RISK; RECIPIENTS; HYPERINSULINEMIA; COMPLICATIONS;
D O I
10.1097/TP.0b013e31819cc3e6
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
071005 [微生物学]; 100108 [医学免疫学];
摘要
Background. Surgical site infection (SSI) is a common postoperative complication associated with increased morbidity and mortality in patients undergoing liver transplantation (LT). Although intraoperative hyperglycemia has been shown to be associated with adverse postoperative outcomes including overall infection rate in LT patients, a relationship between intraoperative hyperglycemia and SSI in LT has not been established. We sought to determine if intraoperative hyperglycemia was associated with SSI after LT. Methods. Patients undergoing LT at our medical center between January 2004 and November 2007 were included in the study. Recipient, donor, and intraoperative variables including a variety of glucose indices were retrospectively analyzed. Independent risk factors of SSI were identified using a multivariate logistic regression model. Results. Of 680 patients, 76 (11.2%) experienced postoperative SSIs. Among all intraoperative glucose indices analyzed, severe hyperglycemia (>= 200 mg/dL) was independently associated with postoperative SSI (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.26-4.03, P=0.006). Other independent risk factors include repeat surgery (OR 6.58, 95% CI 3.41-12.69, P<0.001), intraoperative administration of vasopressor (OR 3.14, 95% CI 1.65-5.95, P<0.001), preoperative mechanical ventilation (OR 3.01, 95% CI 1.70-5.33, P<0.001), and combined liver and kidney transplantation (OR 2.95, 95% CI 3.41-12.69, P<0.001). Conclusions. Severe, but not mild or moderate, intraoperative hyperglycemia is independently associated with postoperative SSI and should be avoided during LT surgery.
引用
收藏
页码:1031 / 1036
页数:6
相关论文
共 41 条
[1]
POLYMORPHONUCLEAR LEUKOCYTES IN NON-INSULIN-DEPENDENT DIABETES-MELLITUS - ABNORMALITIES IN METABOLISM AND FUNCTION [J].
ALEXIEWICZ, JM ;
KUMAR, D ;
SMOGORZEWSKI, M ;
KLIN, M ;
MASSRY, SG .
ANNALS OF INTERNAL MEDICINE, 1995, 123 (12) :919-+
[2]
Glucose variability and mortality in patients with sepsis [J].
Ali, Naeem A. ;
O'Brien, James M., Jr. ;
Dungan, Kathleen ;
Phillips, Gary ;
Marsh, Clay B. ;
Lemeshow, Stanley ;
Connors, Alfred F., Jr. ;
Preiser, Jean-Charles .
CRITICAL CARE MEDICINE, 2008, 36 (08) :2316-2321
[3]
Poor postoperative blood glucose control increases surgical site infections after surgery for hepato-biliary-pancreatic cancer: a prospective study in a high-volume institute in Japan [J].
Ambiru, S. ;
Kato, A. ;
Kimura, F. ;
Shimizu, H. ;
Yoshidome, H. ;
Otsuka, M. ;
Miyazaki, M. .
JOURNAL OF HOSPITAL INFECTION, 2008, 68 (03) :230-233
[4]
Effect of intraoperative hyperglycemia during liver transplantation [J].
Ammori, John B. ;
Sigakis, Matthew ;
Englesbe, Michael J. ;
O'Reilly, Michael ;
Pelletier, Shawn J. .
JOURNAL OF SURGICAL RESEARCH, 2007, 140 (02) :227-233
[5]
Effect of antibiotic prophylaxis on the risk of surgical site infection in orthotopic liver transplant [J].
Asensio, Angel ;
Ramos, Antonio ;
Cuervas-Mons, Valentin ;
Cordero, Elisa ;
Sanchez-Turrion, Victor ;
Blanes, Marino ;
Cervera, Carlos ;
Gavalda, Joan ;
Aguado, Jose M. ;
Torre-Cisneros, Julian .
LIVER TRANSPLANTATION, 2008, 14 (06) :799-805
[6]
IMPAIRED LEUKOCYTE FUNCTION IN PATIENTS WITH POORLY CONTROLLED DIABETES [J].
BAGDADE, JD ;
ROOT, RK ;
BULGER, RJ .
DIABETES, 1974, 23 (01) :9-15
[7]
SHORT-TERM HYPERGLYCEMIA DEPRESSES IMMUNITY THROUGH NONENZYMATIC GLYCOSYLATION OF CIRCULATING IMMUNOGLOBULIN [J].
BLACK, CT ;
HENNESSEY, PJ ;
ANDRASSY, RJ .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1990, 30 (07) :830-833
[8]
Humoral and cellular immune monitoring might be useful to identify liver transplant recipients at risk for development of infection [J].
Carbone, J. ;
Micheloud, D. ;
Salcedo, M. ;
Rincon, D. ;
Banares, R. ;
Clemente, G. ;
Jensen, J. ;
Sarmiento, E. ;
Rodriguez-Molina, J. ;
Fernandez-Cruz, E. .
TRANSPLANT INFECTIOUS DISEASE, 2008, 10 (06) :396-402
[9]
The relationship between plasma glucose and insulin responses to oral glucose, LDL oxidation, and soluble intercellular adhesion molecule-1 in healthy volunteers [J].
Chen, NG ;
Azhar, S ;
Abbasi, F ;
Carantoni, M ;
Reaven, GM .
ATHEROSCLEROSIS, 2000, 152 (01) :203-208
[10]
COLONNA JO, 1988, ARCH SURG-CHICAGO, V123, P360