Glycaemic control targets after traumatic brain injury: a systematic review and meta-analysis
Abstract Background Optimal glycaemic targets in traumatic brain injury (TBI) remain unclear. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing intensive with conventional glycaemic control in TBI requiring admission to an intensive care unit (ICU)....
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doaj-f2d3397ce5f943669246af0a2a3854f22020-11-25T00:10:48ZengBMCCritical Care1364-85352018-01-0122111110.1186/s13054-017-1883-yGlycaemic control targets after traumatic brain injury: a systematic review and meta-analysisJeroen Hermanides0Mark P. Plummer1Mark Finnis2Adam M. Deane3Jonathan P. Coles4David K. Menon5Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke’s HospitalNeurosciences Critical Care Unit, Addenbrooke’s HospitalIntensive Care Unit, Royal Adelaide HospitalIntensive Care Unit, Royal Melbourne HospitalDivision of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke’s HospitalDivision of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke’s HospitalAbstract Background Optimal glycaemic targets in traumatic brain injury (TBI) remain unclear. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing intensive with conventional glycaemic control in TBI requiring admission to an intensive care unit (ICU). Methods We systematically searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials to November 2016. Outcomes of interest included ICU and in-hospital mortality, poor neurological outcome, the incidence of hypoglycaemia and infective complications. Data were analysed by pairwise random effects models with secondary analysis of differing levels of conventional glycaemic control. Results Ten RCTs, involving 1066 TBI patients were included. Three studies were conducted exclusively in a TBI population, whereas in seven trials, the TBI population was a sub-cohort of a mixed neurocritical or general ICU population. Glycaemic targets with intensive control ranged from 4.4 to 6.7 mmol/L, while conventional targets aimed to keep glucose levels below thresholds of 8.4–12 mmol/L. Conventional versus intensive control showed no association with ICU or hospital mortality (relative risk (RR) (95% CI) 0.93 (0.68–1.27), P = 0.64 and 1.07 (0.84–1.36), P = 0.62, respectively). The risk of a poor neurological outcome was higher with conventional control (RR (95% CI) = 1.10 (1.001–1.24), P = 0.047). However, severe hypoglycaemia occurred less frequently with conventional control (RR (95% CI) = 0.22 (0.09–0.52), P = 0.001). Conclusions This meta-analysis of intensive glycaemic control shows no association with reduced mortality in TBI. Intensive glucose control showed a borderline significant reduction in the risk of poor neurological outcome, but markedly increased the risk of hypoglycaemia. These contradictory findings should motivate further research.http://link.springer.com/article/10.1186/s13054-017-1883-yTraumatic brain injuryGlycaemiaIntensive insulin therapyGlucose controlSystematic review |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jeroen Hermanides Mark P. Plummer Mark Finnis Adam M. Deane Jonathan P. Coles David K. Menon |
spellingShingle |
Jeroen Hermanides Mark P. Plummer Mark Finnis Adam M. Deane Jonathan P. Coles David K. Menon Glycaemic control targets after traumatic brain injury: a systematic review and meta-analysis Critical Care Traumatic brain injury Glycaemia Intensive insulin therapy Glucose control Systematic review |
author_facet |
Jeroen Hermanides Mark P. Plummer Mark Finnis Adam M. Deane Jonathan P. Coles David K. Menon |
author_sort |
Jeroen Hermanides |
title |
Glycaemic control targets after traumatic brain injury: a systematic review and meta-analysis |
title_short |
Glycaemic control targets after traumatic brain injury: a systematic review and meta-analysis |
title_full |
Glycaemic control targets after traumatic brain injury: a systematic review and meta-analysis |
title_fullStr |
Glycaemic control targets after traumatic brain injury: a systematic review and meta-analysis |
title_full_unstemmed |
Glycaemic control targets after traumatic brain injury: a systematic review and meta-analysis |
title_sort |
glycaemic control targets after traumatic brain injury: a systematic review and meta-analysis |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2018-01-01 |
description |
Abstract Background Optimal glycaemic targets in traumatic brain injury (TBI) remain unclear. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing intensive with conventional glycaemic control in TBI requiring admission to an intensive care unit (ICU). Methods We systematically searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials to November 2016. Outcomes of interest included ICU and in-hospital mortality, poor neurological outcome, the incidence of hypoglycaemia and infective complications. Data were analysed by pairwise random effects models with secondary analysis of differing levels of conventional glycaemic control. Results Ten RCTs, involving 1066 TBI patients were included. Three studies were conducted exclusively in a TBI population, whereas in seven trials, the TBI population was a sub-cohort of a mixed neurocritical or general ICU population. Glycaemic targets with intensive control ranged from 4.4 to 6.7 mmol/L, while conventional targets aimed to keep glucose levels below thresholds of 8.4–12 mmol/L. Conventional versus intensive control showed no association with ICU or hospital mortality (relative risk (RR) (95% CI) 0.93 (0.68–1.27), P = 0.64 and 1.07 (0.84–1.36), P = 0.62, respectively). The risk of a poor neurological outcome was higher with conventional control (RR (95% CI) = 1.10 (1.001–1.24), P = 0.047). However, severe hypoglycaemia occurred less frequently with conventional control (RR (95% CI) = 0.22 (0.09–0.52), P = 0.001). Conclusions This meta-analysis of intensive glycaemic control shows no association with reduced mortality in TBI. Intensive glucose control showed a borderline significant reduction in the risk of poor neurological outcome, but markedly increased the risk of hypoglycaemia. These contradictory findings should motivate further research. |
topic |
Traumatic brain injury Glycaemia Intensive insulin therapy Glucose control Systematic review |
url |
http://link.springer.com/article/10.1186/s13054-017-1883-y |
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