Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Shantou 515041, China.
Shantou University Medical College, No. 22 Xinling Road, Shantou 515041, China.
J Diabetes Res. 2021 Feb 2;2021:6681645. doi: 10.1155/2021/6681645. eCollection 2021.
The relationship between obesity and the outcomes of critically ill diabetic patients is not completely clear. We aimed to assess the effects of obesity and overweight on the outcomes among diabetic patients in the intensive care unit (ICU).
Critically ill diabetic patients in the ICU were classified into three groups according to their body mass index. The primary outcomes were 30-day and 90-day mortality. ICU and hospital length of stay (LOS) and incidence and duration of mechanical ventilation were also assessed. Cox regression models were developed to evaluate the relationship between obesity and overweight and mortality.
A total of 6108 eligible patients were included. The 30-day and 90-day mortality in the normal weight group were approximately 1.8 times and 1.5 times higher than in the obesity group and overweight group, respectively ( < 0.001, respectively). Meanwhile, the ICU (median (IQ): 2.9 (1.7, 5.3) vs. 2.7 (1.6, 4.8) vs. 2.8 (1.8, 5.0)) and hospital (median (IQ): 8.3 (5.4, 14.0) vs. 7.9 (5.1, 13.0) vs. 8.3 (5.3, 13.6)) LOS in the obesity group and overweight group were not longer than in the normal weight group. Compared with normal weight patients, obese patients had significantly higher incidence of mechanical ventilation (58.8% vs. 64.7%, < 0.001) but no longer ventilation duration (median (IQ): 19.3 (7.0, 73.1) vs. 19.0 (6.0, 93.7), = 1). Multivariate Cox regression showed that obese and overweight patients had lower 30-day (HR (95% CI): 0.62 (0.51, 0.75); 0.76 (0.62, 0.92), respectively) and 90-day (HR (95% CI): 0.60 (0.51, 0.70); 0.79 (0.67, 0.93), respectively) mortality risks than normal weight patients.
Obesity and overweight were independently associated with greater survival in critically ill diabetic patients, without increasing the ICU and hospital LOS. Large multicenter prospective studies are needed to confirm our findings and the underlying mechanisms warrant further investigation.
肥胖与危重症糖尿病患者结局之间的关系尚不完全清楚。本研究旨在评估肥胖和超重对 ICU 中糖尿病患者结局的影响。
根据 BMI 将 ICU 中危重症糖尿病患者分为三组。主要结局为 30 天和 90 天死亡率。还评估了 ICU 和住院时间（LOS）以及机械通气的发生率和持续时间。采用 Cox 回归模型评估肥胖和超重与死亡率之间的关系。
共纳入 6108 例符合条件的患者。与肥胖组和超重组相比，正常体重组的 30 天和 90 天死亡率分别高约 1.8 倍和 1.5 倍（均<0.001）。同时，肥胖组和超重组 ICU（中位数（IQR）：2.9（1.7，5.3）比 2.7（1.6，4.8）比 2.8（1.8，5.0））和住院（中位数（IQR）：8.3（5.4，14.0）比 7.9（5.1，13.0）比 8.3（5.3，13.6））LOS 并不长于正常体重组。与正常体重患者相比，肥胖患者机械通气的发生率明显更高（58.8%比 64.7%，<0.001），但通气时间无明显延长（中位数（IQR）：19.3（7.0，73.1）比 19.0（6.0，93.7），=1）。多变量 Cox 回归显示，肥胖和超重患者 30 天（HR（95%CI）：0.62（0.51，0.75）；0.76（0.62，0.92））和 90 天（HR（95%CI）：0.60（0.51，0.70）；0.79（0.67，0.93））死亡率风险均低于正常体重患者。
肥胖和超重与危重症糖尿病患者的生存获益增加相关，而不会增加 ICU 和住院 LOS。需要进行大型多中心前瞻性研究来证实我们的发现，并进一步研究其潜在机制。
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