Abstract
Background and PurposeHyperglycemia (HG) is associated with increased postoperative complications. This study aims to evaluate the effect of HG during supplemental parenteral nutrition (SPN) on short-term prognosis in non-diabetic patients undergoing gastrectomy for cancer and to analyse the risk factors and prevention methods for HG.MethodsA total of 359 patients were divided into three groups according to blood glucose (BG) during SPN: normoglycemic patients ( ≤ 125 mg/dL), mild HG (125~200 mg/dL), and severe HG (>200 mg/dL). The effect of BG on postoperative short-term outcomes was analyzed. Multivariate regression was performed to investigate influencing factors for severe HG. The safety and efficacy of insulin addition to total nutrient admixture (TNA) for the prevention and management of HG were assessed by propensity score matching (PSM). In addition, regression analysis was performed in the noninsulin group to investigate the predictive factors of severe HG, and a nomogram was plotted.ResultsThe postoperative complication rate was 18.9%, but it was significantly higher in patients with severe HG than in mild HG and normoglycemic patients (25.2, 15.0, and 10.0%, respectively, p < 0.05). Multivariate logistic regression analysis showed that anemia, myosteatosis, higher postoperative capillary blood glucose (CBG) before TNA infusion, and insulin in the TNA were independent influencing factors for severe HG. Based on the above factors, 75 pairs of patients (insulin group and non-insulin group) with comparable baseline data were successfully matched by PSM. The HG incidence and the glycemic fluctuation were significantly improved through 1 U insulin/6 g glucose (1/6 scheme) to TNA. A nomogram containing hemoglobin, skeletal muscle radiodensity, pre-SPN CBG, and pTNM stage with good predictive efficacy (C-index: 0.750) was constructed based on the noninsulin group.ConclusionPoor postoperative glycemic control was related to worse outcomes in non-diabetic patients undergoing gastrectomy for cancer. Pre-operative anemia, myosteatosis, and high postoperative CBG before TNA infusion are risk factors for severe HG. Insulin in TNA can improve the blood glucose control of patients. Our proposed nomogram rendered an individualized predictive tool for HG during SPN, which helps screen high-risk patients requiring insulin therapy. Future studies with larger samples are needed to develop a complete insulin application protocol for SPN.
Highlights
Hyperglycemia (HG) is a common complication in hospitalized patients, occurring in 46% of intensive care unit (ICU) patients and 32% of non-ICU patients [1]
This study aims to evaluate the current situation of HG for patients who need supplemental parenteral nutrition (SPN) after gastrectomy in a highincidence area of Gastric cancer (GC) in China
Of 445 patients, 40 (9.0%) patients had preexisting diabetes mellitus (DM) or random venous plasma glucose (VPG)>200 mg/dL, 12 (2.7%) patients had a history of malignant tumor origins from other tissue, 12 (2.7%) patients were directly transferred to the ICU after the operation, and 17 (3.8%) patients had incomplete oerioperative data
Summary
Hyperglycemia (HG) is a common complication in hospitalized patients, occurring in 46% of intensive care unit (ICU) patients and 32% of non-ICU patients [1]. Poor perioperative blood glucose (BG) control is closely associated with increased postoperative complications and mortality in colorectal, cardiac, and neurosurgery [2,3,4,5,6,7]. In 2017, Claudio Fiorillo et al reviewed 173 nondiabetic patients who underwent gastrectomy and found that postoperative HG (BG>125 mg/dL) was a risk factor for higher postoperative mortality and complication rates [8], and postoperative HG was independently associated with decreased overall survival (OS) and disease-free survival (DFS) [9]. Perioperative nutritional treatment should be given to patients with nutritional risk screening (NRS-2002) ≥3 scores, which combines EN and supplemental parenteral nutrition (SPN). This study aims to evaluate the effect of HG during supplemental parenteral nutrition (SPN) on short-term prognosis in non-diabetic patients undergoing gastrectomy for cancer and to analyse the risk factors and prevention methods for HG
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