Intensive Insulin Therapy for Septic Patients: A Meta-Analysis of Randomized Controlled Trials
Background. Studies on the effect of intensive insulin therapy (IIT) in septic patients with hyperglycemia have given inconsistent results. The primary purpose of this meta-analysis was to evaluate whether it is effective in reducing mortality. Methods. We searched PubMed, Embase, the Cochrane Libra...
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Online Access: | http://dx.doi.org/10.1155/2014/698265 |
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doaj-e684e7c55a35425586c1cfd51f06e1452020-11-25T02:29:36ZengHindawi LimitedBioMed Research International2314-61332314-61412014-01-01201410.1155/2014/698265698265Intensive Insulin Therapy for Septic Patients: A Meta-Analysis of Randomized Controlled TrialsFang Song0Liu-Jun Zhong1Liang Han2Guo-Hao Xie3Cheng Xiao4Bing Zhao5Yao-Qin Hu6Shu-Yan Wang7Chao-Jin Qin8Yan Zhang9Deng-Ming Lai10Ping Cui11Xiang-Ming Fang12School of Medicine, Zhejiang University, Yuhangtang Road 866, Hangzhou 310058, ChinaDepartment of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, ChinaDepartment of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, ChinaDepartment of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, ChinaDepartment of Surgical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, ChinaDepartment of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, ChinaDepartment of Surgery, Children’s Hospital, School of Medicine, Zhejiang University, Zhuganxiang 57, Hangzhou 310003, ChinaDepartment of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, ChinaDepartment of Surgery, Children’s Hospital, School of Medicine, Zhejiang University, Zhuganxiang 57, Hangzhou 310003, ChinaDepartment of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, ChinaDepartment of Surgery, Children’s Hospital, School of Medicine, Zhejiang University, Zhuganxiang 57, Hangzhou 310003, ChinaDepartment of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, ChinaDepartment of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, ChinaBackground. Studies on the effect of intensive insulin therapy (IIT) in septic patients with hyperglycemia have given inconsistent results. The primary purpose of this meta-analysis was to evaluate whether it is effective in reducing mortality. Methods. We searched PubMed, Embase, the Cochrane Library, clinicaltrials.gov, and relevant reference lists up to September 2013 and including randomized controlled trials that compared IIT with conventional glucose management in septic patients. Study quality was assessed using the Cochrane Risk of Bias Tool. And our primary outcome measure was pooled in the random effects model. Results. We identified twelve randomized controlled trials involving 4100 patients. Meta-analysis showed that IIT did not reduce any of the outcomes: overall mortality (risk ratio [RR] = 0.98, 95% CI [0.85, 1.15], P=0.84), 28-day mortality (RR = 0.66, 95% CI [0.40, 1.10], P=0.11), 90-day mortality (RR = 1.10, 95% CI [0.97, 1.26], P=0.13), ICU mortality (RR = 0.94, 95% CI [0.77, 1.14], P=0.52), hospital mortality (RR = 0.98, 95% CI [0.86, 1.11], P=0.71), severity of illness, and length of ICU stay. Conversely, the incidence of hypoglycemia was markedly higher in the IIT (RR = 2.93, 95% CI [1.69, 5.06], P=0.0001). Conclusions. For patients with sepsis, IIT and conservative glucose management show similar efficacy, but ITT is associated with a higher incidence of hypoglycemia.http://dx.doi.org/10.1155/2014/698265 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Fang Song Liu-Jun Zhong Liang Han Guo-Hao Xie Cheng Xiao Bing Zhao Yao-Qin Hu Shu-Yan Wang Chao-Jin Qin Yan Zhang Deng-Ming Lai Ping Cui Xiang-Ming Fang |
spellingShingle |
Fang Song Liu-Jun Zhong Liang Han Guo-Hao Xie Cheng Xiao Bing Zhao Yao-Qin Hu Shu-Yan Wang Chao-Jin Qin Yan Zhang Deng-Ming Lai Ping Cui Xiang-Ming Fang Intensive Insulin Therapy for Septic Patients: A Meta-Analysis of Randomized Controlled Trials BioMed Research International |
author_facet |
Fang Song Liu-Jun Zhong Liang Han Guo-Hao Xie Cheng Xiao Bing Zhao Yao-Qin Hu Shu-Yan Wang Chao-Jin Qin Yan Zhang Deng-Ming Lai Ping Cui Xiang-Ming Fang |
author_sort |
Fang Song |
title |
Intensive Insulin Therapy for Septic Patients: A Meta-Analysis of Randomized Controlled Trials |
title_short |
Intensive Insulin Therapy for Septic Patients: A Meta-Analysis of Randomized Controlled Trials |
title_full |
Intensive Insulin Therapy for Septic Patients: A Meta-Analysis of Randomized Controlled Trials |
title_fullStr |
Intensive Insulin Therapy for Septic Patients: A Meta-Analysis of Randomized Controlled Trials |
title_full_unstemmed |
Intensive Insulin Therapy for Septic Patients: A Meta-Analysis of Randomized Controlled Trials |
title_sort |
intensive insulin therapy for septic patients: a meta-analysis of randomized controlled trials |
publisher |
Hindawi Limited |
series |
BioMed Research International |
issn |
2314-6133 2314-6141 |
publishDate |
2014-01-01 |
description |
Background. Studies on the effect of intensive insulin therapy (IIT) in septic patients with hyperglycemia have given inconsistent results. The primary purpose of this meta-analysis was to evaluate whether it is effective in reducing mortality. Methods. We searched PubMed, Embase, the Cochrane Library, clinicaltrials.gov, and relevant reference lists up to September 2013 and including randomized controlled trials that compared IIT with conventional glucose management in septic patients. Study quality was assessed using the Cochrane Risk of Bias Tool. And our primary outcome measure was pooled in the random effects model. Results. We identified twelve randomized controlled trials involving 4100 patients. Meta-analysis showed that IIT did not reduce any of the outcomes: overall mortality (risk ratio [RR] = 0.98, 95% CI [0.85, 1.15], P=0.84), 28-day mortality (RR = 0.66, 95% CI [0.40, 1.10], P=0.11), 90-day mortality (RR = 1.10, 95% CI [0.97, 1.26], P=0.13), ICU mortality (RR = 0.94, 95% CI [0.77, 1.14], P=0.52), hospital mortality (RR = 0.98, 95% CI [0.86, 1.11], P=0.71), severity of illness, and length of ICU stay. Conversely, the incidence of hypoglycemia was markedly higher in the IIT (RR = 2.93, 95% CI [1.69, 5.06], P=0.0001). Conclusions. For patients with sepsis, IIT and conservative glucose management show similar efficacy, but ITT is associated with a higher incidence of hypoglycemia. |
url |
http://dx.doi.org/10.1155/2014/698265 |
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