Intensive versus conventional glucose control in critically ill patients with traumatic brain injury: long-term follow-up of a subgroup of patients from the NICE-SUGAR study
Intensive versus conventional glucose control in critically ill patients with traumatic brain injury: long-term follow-up of a subgroup of patients from the NICE-SUGAR study
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DOI：
10.1007/s00134-015-3757-6
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发表时间：
2015-06-01
影响因子：
38.9
通讯作者：
Finfer, Simon
中科院分区：
文献类型：
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作者：
Finfer, Simon
旨在比较强化与传统血糖控制对创伤性脑损伤患者的效果。在一项大型国际随机试验中，患者被随机分配到 4.5-6.0 mmol/L（强化控制）或 < 10 mmol/L（传统控制）的目标血糖 (BG) 范围。随机确定患有创伤性脑损伤 (TBI) 的患者，并收集数据以检查 24 个月时的扩展格拉斯哥结局评分（包括死亡率）。在 6104 名随机患者中，391 名满足 TBI 诊断标准； 203 名（51.9%）被分配到强化控制，188 名（48.1%）被分配到常规控制；主要结局分别适用于 166 名 (81.8%) 和 149 名 (79.3%) 患者。两组具有相似的基线特征。 2 年时，强化组中的 98 名患者 (58.7%) 和常规组中的 79 名患者 (53.0%) 获得了良好的神经学结果（比值比 [OR] 1.26，95% CI 0.81-1.97；P = 0.3）；强化组有 35 名患者（20.9%）死亡，常规组有 34 名患者（22.8%）死亡（OR 0.90，95% CI 0.53-1.53；P = 0.7）；中度低血糖（BG 2.3-3.9 mmol/L；41-70 mg/dL）分别发生在 160/202 (79.2 %) 和 17/188 (9.0 %) 中（OR 38.3，95 % CI 21.0-70.1；P < 0.0001）；严重低血糖（BG 千分之一货币符号 2.2 mmol/L；千分之一货币符号 40 mg/dL）分别为 10 (4.9 %) 和 0 (0.0 %)（OR 20.5 95 % CI 1.2-351.6，P = 0.003）。尽管与传统血糖控制相比，随机分配至强化治疗的创伤性脑损伤患者经历了中度和重度低血糖低血糖更频繁，我们发现临床重要结果没有显着差异。
To compare the effect of intensive versus conventional blood glucose control in patients with traumatic brain injury.In a large international randomized trial patients were randomly assigned to a target blood glucose (BG) range of either 4.5-6.0 mmol/L (intensive control) or < 10 mmol/L (conventional control). Patients with traumatic brain injury (TBI) were identified at randomization and data were collected to examine the extended Glasgow outcome score (includes mortality) at 24 months.Of the 6104 randomized patients, 391 satisfied diagnostic criteria for TBI; 203 (51.9 %) were assigned to intensive and 188 (48.1 %) to conventional control; the primary outcome was available for 166 (81.8 %) and 149 (79.3 %) patients, respectively. The two groups hadsimilar baseline characteristics. At 2 years 98 (58.7 %) patients in the intensive group and 79 (53.0 %) in the conventional group had a favorable neurological outcome (odds ratio [OR] 1.26, 95 % CI 0.81-1.97; P = 0.3); 35 patients (20.9 %) in the intensive group and 34 (22.8 %) in the conventional group had died (OR 0.90, 95 % CI 0.53-1.53; P = 0.7); moderate hypoglycemia (BG 2.3-3.9 mmol/L; 41-70 mg/dL) occurred in 160/202 (79.2 %) and 17/188 (9.0 %), respectively (OR 38.3, 95 % CI 21.0-70.1; P < 0.0001); severe hypoglycemia (BG a parts per thousand currency sign 2.2 mmol/L; a parts per thousand currency sign40 mg/dL) in 10 (4.9 %) and 0 (0.0 %), respectively (OR 20.5 95 % CI 1.2-351.6, P = 0.003).Although patients with traumatic brain injury randomly assigned to intensive compared to conventional glucose control experienced moderate and severe hypoglycemia more frequently, we found no significant difference in clinically important outcomes.