Prior GLP-1 agonist use is not associated with adverse inpatient critical care outcomes: A propensity-matched analysis.

Abstract

Glucagon-like peptide-1 (GLP-1) agonists are increasingly prescribed for obesity and type 2 diabetes. GLP-1 agonists influence body composition through effects on both fat mass and fat-free mass. Given that critically ill patients experience severe protein catabolism and commonly develop intensive care unit (ICU)-acquired weakness, questions arise about outcomes when metabolic demands are high during critical illness. The objective of this study is to examine the relationship between prior GLP-1 agonist use and critical care outcomes. We conducted a retrospective cohort study using Stanford Health Care data from January 2015 to July 2024. Adults aged 18-89 years admitted to intensive care with body mass index (BMI) 20-60 kg/m² were included. Of 15,191 eligible ICU patients, 468 (3.1%) received GLP-1 agonist prescriptions within 12 months before hospitalization. Using high-dimensional propensity score matching with lasso regression, we created 452 matched pairs and compared in-hospital mortality, hospital length of stay, and ICU length of stay between groups. Baseline characteristics were well-balanced. The matched GLP-1 agonist and comparison groups showed similar in-hospital mortality (5.1% vs. 4.9%, odds ratio [OR]: 1.05, 95% confidence interval [CI]: 0.58 to 1.91, p = .88), mean hospital length of stay (13.7 ± 21.3 vs. 13.4 ± 18.1 days, mean difference [MD]: 0.38, 95% CI: -2.21 to 3.05, p = .77), and ICU length of stay (5.9 ± 9.0 vs. 5.4 ± 6.6 days, MD: 0.51, 95% CI: -0.52 to 1.50, p = .33). In this first study examining the relationship between prior GLP-1 agonist use and critical care outcomes, we found no significant associations with in-hospital mortality, hospital length of stay, or ICU length of stay.