Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

LUNG SAFE Investigators, ESICM Trials Group

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013.

Original languageEnglish
Article number268
JournalCritical Care
Volume22
Issue number1
DOIs
Publication statusPublished - Oct 27 2018

Fingerprint

Adult Respiratory Distress Syndrome
Respiratory Insufficiency
Databases
Diabetes Mellitus
Hospital Mortality
Critical Illness
Observational Studies
Intensive Care Units
Propensity Score
Artificial Respiration
Heart Failure

Keywords

  • Acute hypoxemic respiratory failure
  • Acute respiratory distress syndrome
  • Diabetes mellitus
  • LUNG SAFE

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure : an analysis of the LUNG SAFE database. / LUNG SAFE Investigators; ESICM Trials Group.

In: Critical Care, Vol. 22, No. 1, 268, 27.10.2018.

Research output: Contribution to journalArticle

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title = "Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database",
abstract = "Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6{\%}) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2{\%} of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013.",
keywords = "Acute hypoxemic respiratory failure, Acute respiratory distress syndrome, Diabetes mellitus, LUNG SAFE",
author = "{LUNG SAFE Investigators} and {ESICM Trials Group} and Boyle, {Andrew J.} and Fabiana Madotto and Laffey, {John G.} and Giacomo Bellani and T{\`a}i Pham and Antonio Pesenti and Thompson, {B. Taylor} and O'Kane, {Cecilia M.} and Deane, {Adam M.} and McAuley, {Daniel F.} and F. Rios and {Van Haren}, F. and Faruq, {M. O.} and T. Sottiaux and P. Depuydt and Lora, {F. S.} and Azevedo, {L. C.} and E. Fan and G. Bugedo and H. Qiu and M. Gonzalez and J. Silesky and V. Cerny and J. Nielsen and M. Jibaja and H. Wrigge and D. Matamis and Ranero, {J. L.} and C. Gomersall and P. Amin and Hashemian, {S. M.} and K. Clarkson and K. Kurahashi and Y. Koh and A. Villagomez and Zeggwagh, {A. A.} and Heunks, {L. M.} and Laake, {J. H.} and W. Kashif and J. Synclair and Palo, {J. E.} and {do Vale Fernandes}, A. and D. Sandesc and Y. Arabi and V. Bumbasierevic and N. Nin and Lorente, {J. A.} and A. Larsson and L. Piquilloud and K. Shimizu",
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language = "English",
volume = "22",
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TY - JOUR

T1 - Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure

T2 - an analysis of the LUNG SAFE database

AU - LUNG SAFE Investigators

AU - ESICM Trials Group

AU - Boyle, Andrew J.

AU - Madotto, Fabiana

AU - Laffey, John G.

AU - Bellani, Giacomo

AU - Pham, Tài

AU - Pesenti, Antonio

AU - Thompson, B. Taylor

AU - O'Kane, Cecilia M.

AU - Deane, Adam M.

AU - McAuley, Daniel F.

AU - Rios, F.

AU - Van Haren, F.

AU - Faruq, M. O.

AU - Sottiaux, T.

AU - Depuydt, P.

AU - Lora, F. S.

AU - Azevedo, L. C.

AU - Fan, E.

AU - Bugedo, G.

AU - Qiu, H.

AU - Gonzalez, M.

AU - Silesky, J.

AU - Cerny, V.

AU - Nielsen, J.

AU - Jibaja, M.

AU - Wrigge, H.

AU - Matamis, D.

AU - Ranero, J. L.

AU - Gomersall, C.

AU - Amin, P.

AU - Hashemian, S. M.

AU - Clarkson, K.

AU - Kurahashi, K.

AU - Koh, Y.

AU - Villagomez, A.

AU - Zeggwagh, A. A.

AU - Heunks, L. M.

AU - Laake, J. H.

AU - Kashif, W.

AU - Synclair, J.

AU - Palo, J. E.

AU - do Vale Fernandes, A.

AU - Sandesc, D.

AU - Arabi, Y.

AU - Bumbasierevic, V.

AU - Nin, N.

AU - Lorente, J. A.

AU - Larsson, A.

AU - Piquilloud, L.

AU - Shimizu, K.

PY - 2018/10/27

Y1 - 2018/10/27

N2 - Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013.

AB - Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013.

KW - Acute hypoxemic respiratory failure

KW - Acute respiratory distress syndrome

KW - Diabetes mellitus

KW - LUNG SAFE

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