Contrasting effects of preexisting hyperglycemia and higher body size on hospital mortality in critically ill patients: a prospective cohort study

BMC Endocrine Disorders

Fernando Gerchman³  Luis Henrique Canani³  Jorge Luiz Gross³  Silvia Regina Vieira¹  Vanessa Bielefeldt Leotti Torman²  Manoella Freitas Santos³  Amanda Rodrigues Fabbrin³  Rafael Barberena Moraes¹  Marina Verçoza Viana¹ 

[1] Intensive Care Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil;Department of Statistics, Federal University of Rio Grande do Sul, and Research and Post-Graduation Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil;Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

关键词: Mortality;    Intensive care unit;    Obesity;    Glycated hemoglobin;    Diabetes mellitus;   

Others  :  864912
DOI  :  10.1186/1472-6823-14-50

 received in 2013-11-12, accepted in 2014-06-11,  发布年份 2014

【 摘 要 】

Background

Obesity and diabetes mellitus are well-defined risk factors for cardiovascular mortality. The impact of antecedent hyperglycemia and body size on mortality in critical ill patients in intensive care units (ICUs) may vary across their range of values. Therefore, we prospectively analyzed the relationship between in-hospital mortality and preexisting hyperglycemia and body size in critically ill ICU patients to understand how mortality varied among normal, overweight, and obese patients and those with low, intermediate, and high glycated hemoglobin (HbA_1c) levels.

Methods

Medical history, weight, height, physiologic variables, and HbA_1c were obtained during the first 24 h for patients who were consecutively admitted to the high complexity ICU of Hospital de Clínicas de Porto Alegre, Brazil, from April to August 2011. The relationships between mortality and obesity and antecedent hyperglycemia were prospectively analyzed by cubic spline analysis and a Cox proportional hazards model.

Results

The study comprised 199 patients. The overall hospital mortality rate was 43.2% during a median 16 (8–28) days of follow-up. There was a progressive risk of in-hospital mortality with higher HbA_1c levels, with the relationship becoming significant at HbA_1c >9.3% compared with lower levels (hazard ratio 1.74; 95% confidence interval with Bonferroni correction 1.49–2.80). In contrast, mean body mass index (BMI) was higher in survivors than in nonsurvivors (27.2 kg/m² ± 7.3 vs. 24.7 kg/m² ± 5.0 P = 0.031, respectively). Cubic spline analysis showed that these relationships differed nonlinearly through the spectrum of BMI values. In a Cox proportional hazards model adjusted for Acute Physiology and Chronic Health Evaluation II score and HbA_1c, the risk of in-hospital mortality progressively decreased with increasing BMI (BMI <20 vs. 20–23.9 kg/m², P = 0.032; BMI <20 vs. 24–34.9 kg/m², P = 0.010; BMI <20 vs. ≥35 kg/m², P = 0.032).

Conclusions

Our findings suggest that significant hyperglycemia prior to ICU admission is a risk factor for in-hospital mortality. Conversely, increasing BMI may confer an advantageous effect against mortality in critical illness independently of previous glycemic control.

【 授权许可】

   
2014 Viana et al.; licensee BioMed Central Ltd.

【 图 表 】

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