Insulin therapy for critically ill hospitalized patients - A meta-analysis of randomized controlled trials
Insulin therapy for critically ill hospitalized patients - A meta-analysis of randomized controlled trials
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DOI：
10.1001/archinte.164.18.2005
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发表时间：
2004-10-11
影响因子：
--
通讯作者：
Lau, J
中科院分区：
文献类型：
--
作者：
Pittas, AG;Siegel, RD;Lau, J
背景：高血糖在危重住院患者中很常见，并与包括死亡率增加在内的不良结局相关。本荟萃分析的目的是确定住院期间开始胰岛素治疗对危重症成人患者死亡率的影响。方法：电子检索MEDLINE和Cochrane对照临床试验注册（Cochrane Controlled Clinical Trials Register）的英文文章，手工检索重点期刊和相关综述文章。随机对照试验报告了重症住院成人患者接受胰岛素治疗的死亡率数据。提取了患者人口统计学、医院环境、干预措施（胰岛素的配方和剂量、给药方法和治疗持续时间）、死亡率结局、不良事件和方法学质量等数据。结果：35项试验符合纳入标准，使用随机效应模型综合所有试验的数据显示，胰岛素治疗可使短期死亡率降低15%（相对危险度[RR]， 0.85； 95%可信区间[CI]， 0.75-0.97）。在亚组分析中，胰岛素治疗降低了外科重症监护病房的死亡率（RR, 0.58; 95% CI, 0.22-0.62），当治疗的目的是控制血糖时（RR, 0.71; 95% Cl, 0.54-0.93），以及糖尿病患者（RR, 0.73; 95% CI, 0.58-0.90）。未接受再灌注治疗的急性心肌梗死患者死亡率有接近显著的下降趋势（RR, 0.84; 95% CI, 0.71-1.00）。在重症监护病房中没有发现胰岛素的随机试验。结论：在不同的临床环境下，危重病人在医院开始胰岛素治疗对短期死亡率有有益的影响。
Background: Hyperglycemia is common in critically ill hospitalized patients, and it is associated with adverse outcomes, including increased mortality. The objective of this meta-analysis was to determine the effect of insulin therapy initiated during hospitalization on mortality in adult patients with a critical illness.Methods: Am electronic search in the English-language articles of MEDLINE and the Cochrane Controlled Clinical Trials Register and a hand search of key journals and relevant review articles were performed. Randomized controlled trials that reported mortality data on critically ill hospitalized adult patients who were treated with insulin were selected. Data on patient demographics, hospital setting, intervention (formulation and dosage of insulin, delivery method, and duration of therapy), mortality outcomes, adverse events, and methodological quality were extracted.Results: Thirty-five trials met the inclusion criteria Combining data from all trials using a random-effects model showed that insulin therapy decreases short-term mortality by 15% (relative risk [RR], 0.85; 95% confidence interval [CI], 0.75-0.97). In subgroup analyses, insulin therapy decreased mortality in the surgical intensive care unit (RR, 0.58; 95% CI, 0.22-0.62), when the aim of therapy was glucose control (RR, 0.71; 95% Cl, 0.54-0.93), and in patients with diabetes mellitus (RR, 0.73; 95% CI, 0.58-0.90). A near-significant trend toward decreasing mortality was seen in patients with acute myocardial infarction who did not receive reperfusion therapy (RR, 0.84; 95% CI, 0.71-1.00). No randomized trials of insulin in the medical intensive care unit were identified.Conclusion: Insulin therapy initiated in the hospital in critically ill patients has a beneficial effect on short-term mortality in different clinical settings.