Association and predictive ability between significant perioperative cardiovascular adverse events and stress glucose rise in patients undergoing non-cardiac surgery
Authors' conclusion
The SHR was related with an increased risk of perioperative MACEs in patients following noncardiac surgery, highlighting its potential as a useful and reliable predictive tool for assessing the risk of perioperative MACEs.
Study context
- Population
- Patients (diabetic and non-diabetic) undergoing noncardiac surgery 2011–2020, perioperative medicine database (INSPIRE 1.1)
- Participants
- 5,609 patients
- Exposure
- Stress hyperglycemia ratio (SHR) tertiles; incremental predictive value of SHR for perioperative MACE
- Outcome
- Major perioperative adverse cardiovascular events (MACEs)
- Follow-up
- Perioperative
Methodological detailsSHR tertiles, Cox proportional hazards regression, restricted cubic spline, Boruta algorithm and machine learning
- SHR tertiles
- Cox proportional hazards regression
- Restricted cubic spline
- Boruta algorithm and machine learning
Main finding
As reported in the abstract
Inflection point for MACE
SHR = 0.81
Inflection point for cardiac death
SHR = 0.97
Observational data: associations, not effects.
Further findings
Incremental predictive value of SHR added to model
- Continuous net reclassification improvement (NRI)
- 0.067 (95% CI: 0.025-0.137, P < 0.001)
- Integrated discrimination improvement (IDI)
- 0.305 (95% CI: 0.155-0.430, P < 0.001)
Incremental predictive value of SHR >0.81 as categorical variable
- C-statistic
- 0.785 (95% CI: 0.756-0.814)
- ΔC-statistic
- 0.035 (P = 0.009)
- Continuous NRI
- 0.007 (95% CI: 0.000-0.021, P = 0.016)
- IDI
- 0.076 (95% CI −0.024-0.142, P = 0.092)
Original publication
Association and predictive ability between significant perioperative cardiovascular adverse events and stress glucose rise in patients undergoing non-cardiac surgery. Cardiovasc Diabetol. Published 18 December 2024. doi:10.
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