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01.06.2015 | Original

Intensive versus conventional glucose control in critically ill patients with traumatic brain injury: long-term follow-up of a subgroup of patients from the NICE-SUGAR study

verfasst von: The NICE-SUGAR Study Investigators for the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group

Erschienen in: Intensive Care Medicine | Ausgabe 6/2015

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Abstract

Purpose

To compare the effect of intensive versus conventional blood glucose control in patients with traumatic brain injury.

Methods

In a large international randomized trial patients were randomly assigned to a target blood glucose (BG) range of either 4.5–6.0 mmol/L (intensive control) or <10 mmol/L (conventional control). Patients with traumatic brain injury (TBI) were identified at randomization and data were collected to examine the extended Glasgow outcome score (includes mortality) at 24 months.

Results

Of the 6104 randomized patients, 391 satisfied diagnostic criteria for TBI; 203 (51.9 %) were assigned to intensive and 188 (48.1 %) to conventional control; the primary outcome was available for 166 (81.8 %) and 149 (79.3 %) patients, respectively. The two groups had

similar baseline characteristics. At 2 years 98 (58.7 %) patients in the intensive group and 79 (53.0 %) in the conventional group had a favorable neurological outcome (odds ratio [OR] 1.26, 95 % CI 0.81–1.97; P = 0.3); 35 patients (20.9 %) in the intensive group and 34 (22.8 %) in the conventional group had died (OR 0.90, 95 % CI 0.53–1.53; P = 0.7); moderate hypoglycemia (BG 2.3–3.9 mmol/L; 41–70 mg/dL) occurred in 160/202 (79.2 %) and 17/188 (9.0 %), respectively (OR 38.3, 95 % CI 21.0–70.1; P < 0.0001); severe hypoglycemia (BG ≤ 2.2 mmol/L; ≤40 mg/dL) in 10 (4.9 %) and 0 (0.0 %), respectively (OR 20.5 95 % CI 1.2–351.6, P = 0.003).

Conclusion

Although patients with traumatic brain injury randomly assigned to intensive compared to conventional glucose control experienced moderate and severe hypoglycemia more frequently, we found no significant difference in clinically important outcomes.

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Titel: Intensive versus conventional glucose control in critically ill patients with traumatic brain injury: long-term follow-up of a subgroup of patients from the NICE-SUGAR study
verfasst von: The NICE-SUGAR Study Investigators for the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group
Publikationsdatum: 01.06.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 6/2015
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-015-3757-6

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Intensive versus conventional glucose control in critically ill patients with traumatic brain injury: long-term follow-up of a subgroup of patients from the NICE-SUGAR study