| Background and Aim:Obesity and impaired glucose metabolism are well-defined risk factors for a lot of disease. The impact of body size on mortality in critical ill patients in intensive care units (ICUs) remains contentious. As one domains of the glucose control, glycemic variability is associated with increased risk of mortality in ICU patients. The aim of this study was to investigate the interaction among BMI, glycemic variability and in-hospital mortality.Methods:Between July 1,2012, and September 30,2015, patients with diabetes or stress-related hyperglycemia who were admitted to the ICU were enrolled. Binary logistic regression analysis was used to assess the relationship between mortality and glucose variability. The relationships between mortality and obesity were analyzed by Cox proportional hazards model. All analyses were performed using the Statistical Package of Social for Windows software Version 20. Statistical significance was defined as p<0.05 for two-tailed analysis.Result:The study comprised 1101 patients. The overall hospital mortality rate was 27.6% during a median 5(2-12) days. Binary logistic regression revealed higher glucose variability to be significantly associated with increased hospital mortality (odds ratio, 1.387; 95% confidence interval,1.009-1.907; P=0.001).In a Cox proportional hazards model adjusted for Acute Physiology and Chronic Health Evaluation II score, mean glucose, standard deviation of blood glucose (GluSD), and the requirement for continuous renal replacement therapy (CRRT) and vasopressor support, the risk of in-hospital mortality progressively decreased with increasing BMI (BMI<18.5 vs. 18.5-23.9 kg/m2, P= 0.030; BMI<18.5 vs.24-27.9 kg/m2, P= 0.006; BMI<18.5 vs. ≥28 kg/m2, P< 0.001)Conclusions:Our findings suggest that greater variability is a risk factor for in-hospital mortality. Conversely, increasing BMI may confer an advantageous effect against mortality in critical illness independently of other factors. |
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