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Inventi Impact: Endocrinology

Articles

  • Inventi:hdb/13977/14
    Contrasting Effects of Preexisting Hyperglycemia and Higher Body Size on Hospital Mortality in\nCritically Ill Patients: A Prospective Cohort Study
    01-Jan-1970 Research 2014 : October - December
    Marina Vercoza Viana, Rafael Barberena Moraes, Amanda Rodrigues Fabbrin, Manoella Freitas Santos, Vanessa Bielefeldt Leotti Torman, Silvia Regina Vieira, Jorge Luiz Gross, Luis Henrique Canani, Fernando Gerchman

    Background\nObesity 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 (HbA1c) levels.\n\nMethods\nMedical history, weight, height, physiologic variables, and HbA1c were obtained during the first 24 h for patients who were consecutively admitted to the high complexity ICU of Hospital de ClÃ?­nicas 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.\n\nResults\nThe study comprised 199 patients. The overall hospital mortality rate was 43.2% during a median 16 (8ââ?¬â??28) days of follow-up. There was a progressive risk of in-hospital mortality with higher HbA1c levels, with the relationship becoming significant at HbA1c >9.3% compared with lower levels (hazard ratio 1.74; 95% confidence interval with Bonferroni correction 1.49ââ?¬â??2.80). In contrast, mean body mass index (BMI) was higher in survivors than in nonsurvivors (27.2 kg/m2?Ã?±?7.3 vs. 24.7 kg/m2?Ã?±?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 HbA1c, the risk of in-hospital mortality progressively decreased with increasing BMI (BMI <20 vs. 20ââ?¬â??23.9 kg/m2, P?=?0.032; BMI <20 vs. 24ââ?¬â??34.9 kg/m2, P?=?0.010; BMI <20 vs. ?35 kg/m2, P?=?0.032).\n\nConclusions\nOur 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.

    How to Cite this Article
    CC Compliant Citation: Viana et al.: Contrasting effects of pre-existing hyperglycemia and higher body size on hospital mortality in critically ill patients: a prospective cohort study. BMC Endocrine Disorders 2014 14:50, doi:10.1186/1472-6823-14-50. © 2014 Viana et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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