A Patient-Level Meta-Analysis of Intensive Glucose Control in Critically Ill Adults.
NEJM Evid
; 3(8): EVIDoa2400082, 2024 Aug.
Article
in En
| MEDLINE
| ID: mdl-38864749
ABSTRACT
BACKGROUND:
Whether intensive glucose control reduces mortality in critically ill patients remains uncertain. Patient-level meta-analyses can provide more precise estimates of treatment effects than are currently available.METHODS:
We pooled individual patient data from randomized trials investigating intensive glucose control in critically ill adults. The primary outcome was in-hospital mortality. Secondary outcomes included survival to 90 days and time to live cessation of treatment with vasopressors or inotropes, mechanical ventilation, and newly commenced renal replacement. Severe hypoglycemia was a safety outcome.RESULTS:
Of 38 eligible trials (n=29,537 participants), 20 (n=14,171 participants) provided individual patient data including in-hospital mortality status for 7059 and 7049 participants allocated to intensive and conventional glucose control, respectively. Of these 1930 (27.3%) and 1891 (26.8%) individuals assigned to intensive and conventional control, respectively, died (risk ratio, 1.02; 95% confidence interval [CI], 0.96 to 1.07; P=0.52; moderate certainty). There was no apparent heterogeneity of treatment effect on in-hospital mortality in any examined subgroups. Intensive glucose control increased the risk of severe hypoglycemia (risk ratio, 3.38; 95% CI, 2.99 to 3.83; P<0.0001).CONCLUSIONS:
Intensive glucose control was not associated with reduced mortality risk but increased the risk of severe hypoglycemia. We did not identify a subgroup of patients in whom intensive glucose control was beneficial. (Funded by the Australian National Health and Medical Research Council and others; PROSPERO number CRD42021278869.).
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Hospital Mortality
/
Critical Illness
/
Hypoglycemia
Limits:
Adult
/
Humans
Language:
En
Journal:
NEJM Evid
Year:
2024
Document type:
Article