Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data
Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data
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DOI：
10.1503/cmaj.090206
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发表时间：
2009-04-14
影响因子：
14.6
通讯作者：
Talmor, Daniel
中科院分区：
文献类型：
--
作者：
Griesdale, Donald E. G.;de Souza, Russell J.;Talmor, Daniel
背景：高血压与危重患者死亡率增加相关。强化胰岛素治疗的随机试验报告了对死亡率和严重低血糖发生率增加的不一致影响。我们进行了一项荟萃分析，以更新有关强化胰岛素治疗与常规胰岛素治疗相比对重症监护室（ICU）死亡率和严重低血糖影响的全部证据。方法：我们对电子数据库、科学会议摘要和相关文章书目进行了检索。我们纳入了已发表的在ICU进行的随机对照试验，这些试验直接比较了强化胰岛素治疗与传统血糖管理，并记录了死亡率。我们纳入了我们的荟萃分析的数据，从最近的NICE-SUGAR（在重症监护评价正常血糖-生存使用葡萄糖算法Regulation）study.Results：我们纳入了26项试验，共涉及13 567例患者在我们的荟萃分析。在报告死亡率的26项试验中，与常规治疗相比，强化胰岛素治疗的合并死亡相对风险（RR）为0.93（95%置信区间[CI] 0.83-1.04）。在报告低血糖的14项试验中，强化胰岛素治疗的汇总RR为6.0（95% CI 4.5-8.0）。ICU环境是一个影响因素，外科ICU中的患者似乎从强化胰岛素治疗中获益（RR 0.63，95% CI 0.44-0.91）;其他ICU环境中的患者没有获益（内科ICU：RR 1.0，95% CI 0.78-1.28;混合ICU：RR 0.99，95% CI 0.86-1.12）。强化胰岛素治疗的不同目标（血糖水平
Background: Hyperglycemia is associated with increased mortality in critically ill patients. Randomized trials of intensive insulin therapy have reported inconsistent effects on mortality and increased rates of severe hypoglycemia. We conducted a meta-analysis to update the totality of evidence regarding the influence of intensive insulin therapy compared with conventional insulin therapy on mortality and severe hypoglycemia in the intensive care unit (ICU).Methods: We conducted searches of electronic databases, abstracts from scientific conferences and bibliographies of relevant articles. We included published randomized controlled trials conducted in the ICU that directly compared intensive insulin therapy with conventional glucose management and that documented mortality. We included in our meta-analysis the data from the recent NICE-SUGAR (Normoglycemia in Intensive Care Evaluation - Survival Using Glucose Algorithm Regulation) study.Results: We included 26 trials involving a total of 13 567 patients in our meta-analysis. Among the 26 trials that reported mortality, the pooled relative risk (RR) of death with intensive insulin therapy compared with conventional therapy was 0.93 (95% confidence interval [CI] 0.83-1.04). Among the 14 trials that reported hypoglycemia, the pooled RR with intensive insulin therapy was 6.0 (95% CI 4.5-8.0). The ICU setting was a contributing factor, with patients in surgical ICUs appearing to benefit from intensive insulin therapy (RR 0.63, 95% CI 0.44-0.91); patients in the other ICU settings did not (medical ICU: RR 1.0, 95% CI 0.78-1.28; mixed ICU: RR 0.99, 95% CI 0.86-1.12). The different targets of intensive insulin therapy (glucose level