Abstract
BackgroundAlthough the associations between obesity, glucose variability (GV), and Intensive Care Unit (ICU) mortality have been studied extensively, whether age moderates these associations is not well understood.Materials and methodsThe medical records of 1062 patients, who were admitted into ICU at Sir Run Run Shaw Hospital (Zhejiang, China), were studied. Logistic regression was used to test the associations between obesity, GV, and ICU mortality. Furthermore, the moderation effect of age was tested.ResultsAfter controlling for covariates, the underweight group had the highest odds of death (OR 2.38, 95% CI 1.43–3.95, p < 0.001) in comparison with the control group (overweight). However, normal weight (OR 1.29, 95% CI 0.88–1.89, p = 0.185) and obese (OR 1.08, 95% CI 0.61–1.90, p = 0.790) groups had similar odds of death, compared to the overweight group. Age significantly moderated the association between obesity and mortality, where being overweight was more advantageous than being normal weight in older adults (B = 0.03, SE = 0.01, OR 1.03, 95% CI 1.001–1.06, p = 0.045). Meanwhile, higher GV predicted greater mortality in adjusted models (OR 1.23, 95% CI 1.06–1.42, p = 0.005). We also found an interaction between age and GV (B = − 0.01, SE = 0.01, OR 0.99, 95% CI 0.98–0.999, p = 0.025), which suggested that the association between GV and mortality becomes weaker with increasing age.ConclusionsWith increasing age, the association between BMI and mortality becomes stronger and the association between glucose variability and mortality becomes weaker. Future studies should investigate the underlying mechanisms of such phenomenon and the causal relationship between obesity, GV, and ICU mortality.
Highlights
The associations between obesity, glucose variability (GV), and Intensive Care Unit (ICU) mortality have been studied extensively, whether age moderates these associations is not well understood
Age significantly moderated the association between obesity and mortality, where being overweight was more advantageous than being normal weight in older adults (B = 0.03, Standard error (SE) = 0.01, Odds ratio (OR) 1.03, 95% Confidence interval (CI) 1.001–1.06, p = 0.045)
We found an interaction between age and GV (B = − 0.01, SE = 0.01, OR 0.99, 95% CI 0.98–0.999, p = 0.025), which suggested that the association between GV and mortality becomes weaker with increasing age
Summary
The associations between obesity, glucose variability (GV), and Intensive Care Unit (ICU) mortality have been studied extensively, whether age moderates these associations is not well understood. Glucose variability (GV) is a risk factor for the mortality among ICU patients that has been studied extensively in recent decades [3,4,5] Both obesity and GV are often ignored when estimating mortality in ICU patients (e.g., via calculating the Acute Physiology and Chronic Health Evaluation II [APACHE II] score). A meta-analysis review on the obesity paradox confirmed a U-shape association between obesity and mortality in patients undergoing cardiac surgeries, where the mortality rates were highest among underweight and extremely obese patients (BMI < 18 or > 35 kg/m2) and lowest among overweight patients [9] This phenomenon was observed among critically ill patients [10]
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