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dc.contributor.authorViana, Marina Verçozapt_BR
dc.contributor.authorMoraes, Rafael Barberenapt_BR
dc.contributor.authorFabbrin, Amanda Rodriguespt_BR
dc.contributor.authorSantos, Manoella Freitaspt_BR
dc.contributor.authorLeotti, Vanessa Bielefeldtpt_BR
dc.contributor.authorVieira, Silvia Regina Riospt_BR
dc.contributor.authorGross, Jorge Luizpt_BR
dc.contributor.authorCanani, Luis Henrique Santospt_BR
dc.contributor.authorGerchman, Fernandopt_BR
dc.date.accessioned2015-03-04T01:58:08Zpt_BR
dc.date.issued2014pt_BR
dc.identifier.issn1472-6823pt_BR
dc.identifier.urihttp://hdl.handle.net/10183/111624pt_BR
dc.description.abstractBackground: 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.en
dc.format.mimetypeapplication/pdf
dc.language.isoengpt_BR
dc.relation.ispartofBMC endocrine disorders. London. Vol. 14 (June 17, 2014), p. 50 [7 p.]pt_BR
dc.rightsOpen Accessen
dc.subjectGlycated hemoglobinen
dc.subjectEstatística médicapt_BR
dc.subjectDiabetes mellituspt_BR
dc.subjectObesityen
dc.subjectObesidadept_BR
dc.subjectIntensive care uniten
dc.subjectMortalityen
dc.subjectTamanho corporalpt_BR
dc.subjectHiperglicemiapt_BR
dc.titleContrasting effects of preexisting hyperglycemia and higher body size on hospital mortality in critically ill patients : a prospective cohort studypt_BR
dc.typeArtigo de periódicopt_BR
dc.identifier.nrb000922578pt_BR
dc.type.originEstrangeiropt_BR


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