Glucose metabolism, not obesity, predicts mortality in critically ill surgical patients
Our hypothesis was to determine if insulin resistance and hyperglycemia, rather than obesity, are predictive of mortality in the surgically critically ill. An observational study of an automated protocol in surgical and trauma intensive care units was performed. Two groups were created based on body...
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| Veröffentlicht in: | The American surgeon 2010-12, Vol.76 (12), p.1377-1383 |
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| creator | Mowery, Nathan T May, Addison K Collier, Bryan C Dossett, Lesly A Gunter, Oliver L Dortch, Marcus J Diaz, Jr, Jose J |
| description | Our hypothesis was to determine if insulin resistance and hyperglycemia, rather than obesity, are predictive of mortality in the surgically critically ill. An observational study of an automated protocol in surgical and trauma intensive care units was performed. Two groups were created based on body mass index (BMI): Obese (OB) defined as BMI > or = 30 (n = 338) and nonobese defined as BMI < 30 (n = 885). Euglycemia was maintained using an automated protocol using an adapting multiplier, which we used as our marker of stress insulin resistance. The primary outcome was hospital mortality. One thousand, two hundred and twenty-three patients met criteria with 73,225 glucose values. The OB group required more insulin (4.5 U/hr vs 3.2 U/hr, P < or = 0.01) and had a higher mean multiplier (0.07 vs 0.06, P < 0.01) reflecting insulin resistance. There was no difference in mortality between OB and nonobese (11.6% vs 11.5%, P = 0.96). Logistic regression showed that insulin dose (odds ratio 0.864; 95% confidence interval 0.772-0.967, P = 0.01), and not BMI, was an independent predictor of survival in this population. Obesity is not an independent risk factor for mortality in the surgical critical care population. Insulin resistance and subsequent hyperglycemia are increased in obesity and are independent predictors of mortality. |
| doi_str_mv | 10.1177/000313481007601223 |
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An observational study of an automated protocol in surgical and trauma intensive care units was performed. Two groups were created based on body mass index (BMI): Obese (OB) defined as BMI > or = 30 (n = 338) and nonobese defined as BMI < 30 (n = 885). Euglycemia was maintained using an automated protocol using an adapting multiplier, which we used as our marker of stress insulin resistance. The primary outcome was hospital mortality. One thousand, two hundred and twenty-three patients met criteria with 73,225 glucose values. The OB group required more insulin (4.5 U/hr vs 3.2 U/hr, P < or = 0.01) and had a higher mean multiplier (0.07 vs 0.06, P < 0.01) reflecting insulin resistance. There was no difference in mortality between OB and nonobese (11.6% vs 11.5%, P = 0.96). Logistic regression showed that insulin dose (odds ratio 0.864; 95% confidence interval 0.772-0.967, P = 0.01), and not BMI, was an independent predictor of survival in this population. Obesity is not an independent risk factor for mortality in the surgical critical care population. Insulin resistance and subsequent hyperglycemia are increased in obesity and are independent predictors of mortality.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/000313481007601223</identifier><identifier>PMID: 21265352</identifier><language>eng</language><publisher>United States: SAGE PUBLICATIONS, INC</publisher><subject>Adult ; Blood glucose ; Blood Glucose - analysis ; Body mass ; Body Mass Index ; Critical Illness - mortality ; Death ; Diabetes ; Diabetes Mellitus - epidemiology ; Female ; Hormones ; Hospitals ; Humans ; Hyperglycemia ; Hyperglycemia - epidemiology ; Insulin resistance ; Insulin Resistance - physiology ; Male ; Metabolism ; Middle Aged ; Mortality ; Obesity ; Obesity - epidemiology ; Obesity - metabolism ; Patients ; Risk factors ; Surgical Procedures, Operative ; Survival Analysis</subject><ispartof>The American surgeon, 2010-12, Vol.76 (12), p.1377-1383</ispartof><rights>Copyright Southeastern Surgical Congress Dec 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c406t-f6a6ad56477a118b1ce5b48c63fdb38614f4f032599db38a1f094b7cb2b9a59e3</citedby><cites>FETCH-LOGICAL-c406t-f6a6ad56477a118b1ce5b48c63fdb38614f4f032599db38a1f094b7cb2b9a59e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27929,27930</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21265352$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mowery, Nathan T</creatorcontrib><creatorcontrib>May, Addison K</creatorcontrib><creatorcontrib>Collier, Bryan C</creatorcontrib><creatorcontrib>Dossett, Lesly A</creatorcontrib><creatorcontrib>Gunter, Oliver L</creatorcontrib><creatorcontrib>Dortch, Marcus J</creatorcontrib><creatorcontrib>Diaz, Jr, Jose J</creatorcontrib><title>Glucose metabolism, not obesity, predicts mortality in critically ill surgical patients</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>Our hypothesis was to determine if insulin resistance and hyperglycemia, rather than obesity, are predictive of mortality in the surgically critically ill. An observational study of an automated protocol in surgical and trauma intensive care units was performed. Two groups were created based on body mass index (BMI): Obese (OB) defined as BMI > or = 30 (n = 338) and nonobese defined as BMI < 30 (n = 885). Euglycemia was maintained using an automated protocol using an adapting multiplier, which we used as our marker of stress insulin resistance. The primary outcome was hospital mortality. One thousand, two hundred and twenty-three patients met criteria with 73,225 glucose values. The OB group required more insulin (4.5 U/hr vs 3.2 U/hr, P < or = 0.01) and had a higher mean multiplier (0.07 vs 0.06, P < 0.01) reflecting insulin resistance. There was no difference in mortality between OB and nonobese (11.6% vs 11.5%, P = 0.96). Logistic regression showed that insulin dose (odds ratio 0.864; 95% confidence interval 0.772-0.967, P = 0.01), and not BMI, was an independent predictor of survival in this population. Obesity is not an independent risk factor for mortality in the surgical critical care population. Insulin resistance and subsequent hyperglycemia are increased in obesity and are independent predictors of mortality.</description><subject>Adult</subject><subject>Blood glucose</subject><subject>Blood Glucose - analysis</subject><subject>Body mass</subject><subject>Body Mass Index</subject><subject>Critical Illness - mortality</subject><subject>Death</subject><subject>Diabetes</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Female</subject><subject>Hormones</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>Hyperglycemia - epidemiology</subject><subject>Insulin resistance</subject><subject>Insulin Resistance - physiology</subject><subject>Male</subject><subject>Metabolism</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Obesity</subject><subject>Obesity - epidemiology</subject><subject>Obesity - metabolism</subject><subject>Patients</subject><subject>Risk factors</subject><subject>Surgical Procedures, Operative</subject><subject>Survival Analysis</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kU1LHTEYhUNR6vXaP9BFCW7qwql58z1LkfoBQjctXQ5JbkYimcltkln475tB66KCq5fz8pwDh4PQZyDfAJS6IIQwYFwDIUoSoJR9QBsQQnS9puwAbVagW4kjdFzKY5NcCviIjihQKZigG_T7Ji4uFY8nX41NMZTpHM-p4mR9CfXpHO-z3wVXC55Sria2Hw4zdjnU4EyMTcWIy5IfVon3pgY_13KCDkcTi__0crfo1_X3n1e33f2Pm7ury_vOcSJrN0ojzU5IrpQB0BacF5ZrJ9m4s0xL4CMfCaOi71dtYCQ9t8pZansjes-26Otz7j6nP4svdZhCcT5GM_u0lEFzJXqpW9stOnuXBAJACdNMNfT0P_QxLXluPQZNqVKCStog-gy5nErJfhz2OUwmP7WkYd1neLtPM315SV7s5Hevln-DsL96w4n8</recordid><startdate>201012</startdate><enddate>201012</enddate><creator>Mowery, Nathan T</creator><creator>May, Addison K</creator><creator>Collier, Bryan C</creator><creator>Dossett, Lesly A</creator><creator>Gunter, Oliver L</creator><creator>Dortch, Marcus J</creator><creator>Diaz, Jr, Jose J</creator><general>SAGE PUBLICATIONS, INC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>S0X</scope><scope>7TS</scope><scope>7X8</scope></search><sort><creationdate>201012</creationdate><title>Glucose metabolism, not obesity, predicts mortality in critically ill surgical patients</title><author>Mowery, Nathan T ; May, Addison K ; Collier, Bryan C ; Dossett, Lesly A ; Gunter, Oliver L ; Dortch, Marcus J ; Diaz, Jr, Jose J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c406t-f6a6ad56477a118b1ce5b48c63fdb38614f4f032599db38a1f094b7cb2b9a59e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Blood glucose</topic><topic>Blood Glucose - 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Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mowery, Nathan T</au><au>May, Addison K</au><au>Collier, Bryan C</au><au>Dossett, Lesly A</au><au>Gunter, Oliver L</au><au>Dortch, Marcus J</au><au>Diaz, Jr, Jose J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Glucose metabolism, not obesity, predicts mortality in critically ill surgical patients</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2010-12</date><risdate>2010</risdate><volume>76</volume><issue>12</issue><spage>1377</spage><epage>1383</epage><pages>1377-1383</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>Our hypothesis was to determine if insulin resistance and hyperglycemia, rather than obesity, are predictive of mortality in the surgically critically ill. An observational study of an automated protocol in surgical and trauma intensive care units was performed. Two groups were created based on body mass index (BMI): Obese (OB) defined as BMI > or = 30 (n = 338) and nonobese defined as BMI < 30 (n = 885). Euglycemia was maintained using an automated protocol using an adapting multiplier, which we used as our marker of stress insulin resistance. The primary outcome was hospital mortality. One thousand, two hundred and twenty-three patients met criteria with 73,225 glucose values. The OB group required more insulin (4.5 U/hr vs 3.2 U/hr, P < or = 0.01) and had a higher mean multiplier (0.07 vs 0.06, P < 0.01) reflecting insulin resistance. There was no difference in mortality between OB and nonobese (11.6% vs 11.5%, P = 0.96). Logistic regression showed that insulin dose (odds ratio 0.864; 95% confidence interval 0.772-0.967, P = 0.01), and not BMI, was an independent predictor of survival in this population. Obesity is not an independent risk factor for mortality in the surgical critical care population. Insulin resistance and subsequent hyperglycemia are increased in obesity and are independent predictors of mortality.</abstract><cop>United States</cop><pub>SAGE PUBLICATIONS, INC</pub><pmid>21265352</pmid><doi>10.1177/000313481007601223</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Blood glucose Blood Glucose - analysis Body mass Body Mass Index Critical Illness - mortality Death Diabetes Diabetes Mellitus - epidemiology Female Hormones Hospitals Humans Hyperglycemia Hyperglycemia - epidemiology Insulin resistance Insulin Resistance - physiology Male Metabolism Middle Aged Mortality Obesity Obesity - epidemiology Obesity - metabolism Patients Risk factors Surgical Procedures, Operative Survival Analysis |
| title | Glucose metabolism, not obesity, predicts mortality in critically ill surgical patients |
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