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

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

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Título Contrasting effects of preexisting hyperglycemia and higher body size on hospital mortality in critically ill patients : a prospective cohort study
Autor Viana, Marina Verçoza
Moraes, Rafael Barberena
Fabbrin, Amanda Rodrigues
Santos, Manoella Freitas
Torman, Vanessa Bielefeldt Leotti
Vieira, Silvia Regina Rios
Gross, Jorge Luiz
Canani, Luis Henrique Santos
Gerchman, Fernando
Abstract 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 (HbA1c) levels. Methods: Medical 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 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 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 1.49–2.80). 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 HbA1c, 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.
Contido em BMC endocrine disorders. London. Vol. 14 (June 17, 2014), p. 50 [7 p.]
Assunto Diabetes mellitus
Estatística médica
Hiperglicemia
Obesidade
Tamanho corporal
[en] Glycated hemoglobin
[en] Intensive care unit
[en] Mortality
[en] Obesity
Origem Estrangeiro
Tipo Artigo de periódico
URI http://hdl.handle.net/10183/111624
Arquivos Descrição Formato
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