Prevalence and Risk Factors of Cardiovascular-Kidney-Metabolic Syndrome in Noncardiac Surgery Patients

Introduction: Cardiovascular-kidney-metabolic (CKM) syndrome is a systemic disease that leads to multiple organ dysfunction and high rates of cardiovascular adverse outcomes. This cross-sectional study examines the prevalence and associated risk factors of different stages of CKM syndrome in non-cardiac surgery patients. METHODS: We enrolled patients preparing for non-cardiac surgery at Xuanwu Hospital of Capital Medical University from December 2017 to December 2020 based on inclusion and exclusion criteria. We divided participants into five CKM stages based on clinical severity and calculated the prevalence of each stage. RESULTS: The final study population consisted of 12415 patients (50.2% female, mean age = 57.12±15.02 years). 15.3% of people met criteria for stage 0 of CKM syndrome, 22.6% for stage 1, 52.4% for stage 2, 1.5% for stage 3, and 8.2% for stage 4. Advanced stages (meaning CKD stage 2, stage 3, and stage 4) occurred in 62.1%. Multivariate logistic regression analysis revealed that, compared to those with young age (18-44 years), age ≥60 years was identified as a risk factor (OR = 4.592, 95% CI 4.138-5.095, P < 0.001). Men were more likely to enter the advanced stage of CKM syndrome (OR = 1.368, 95% CI 1.260-1.485, P < 0.001) compared with women. With general surgery as the control group, surgical patients in neurosurgery (OR = 0.447, 95% CI 0.351-0.568, P < 0.001) and orthopedics (OR = 0.606, 95% CI 0.472-0.778, P < 0.001) departments had a lower risk of entering the advanced stage of CKM syndrome. In addition, higher hs-CRP levels were identified as risk factors (OR =2.930, 95% CI 2.174-3.950, P< 0.001) of CKM syndrome. Receiver operating characteristic analysis showed that body mass index (BMI) was superior to fasting plasma glucose and triglycerides in predicting CKM Syndrome, with area under the curve values of 0.931 vs 0.721 and 0.770, respectively (P < 0.05 for all). CONCLUSION: CKM syndrome is highly prevalent (84.7%) in non-cardiac surgical patients. Gender, age, type of surgery, and higher hs-CRP levels are independent risk factors for CKM syndrome in patients in Noncardiac Surgery.