机构：[1]Critical Care Division, The George Institute for Global Health, Sydney.[2]Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.[3]Medical School, Faculty of Medical Sciences, University College London, London.[4]Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.[5]Royal North Shore Hospital, Malcolm Fisher Department of Intensive Care, St Leonards, NSW, Australia.[6]The George Institute for Global Health, Biostatistics and Data Science Division, Barangaroo, NSW, Australia.[7]Department of Intensive Care, Hopital Raymond-Poincare, Garches, France.[8]PROMETHEUS IHU, Universite Paris-Saclay, Garches, France.[9]Laboratory of Infection & Inflammation, School of Medicine Simone Veil Sante, Universite Paris-Saclay, Montigny Le Bretonneux, France.[10]FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), Garches, France.[11]Intensive Care Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.[12]Department of Anesthesiology and Intensive Care Medicine, University of Rome La Sapienza, Rome.[13]Service d'Anesthesie-Reanimation-Medecine Intensive, Hospices Civils de Lyon, Groupement Hospitalier Sud, Lyon, France.[14]Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.[15]HCor Research Institute, Sao Paulo, Brazil.[16]Departments of Medicine, Clinical Epidemiology & Biostatistics (Division of Critical Care), McMaster University, Hamilton, ON, Canada.[17]Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany.[18]Department of Neurology, Tufts University School of Medicine, Boston.[19]Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing.临床科室重症医学科-中心ICU首都医科大学附属北京同仁医院首都医科大学附属同仁医院[20]Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.[21]Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.[22]Anestesiologia e Rianimazione, Universita degli Studi di Milano, Milan.[23]La Casamance Private Hospital, Aubagne, France.[24]Hospital Pablo Tobon Uribe, Medellin, Colombia.[25]School of Science, Western Sydney University, Campbelltown, NSW, Australia.[26]InterSystems Corporation, Cambridge, MA.[27]Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, St Leonards, NSW, Australia.[28]Faculte de Medecine, Universite Libre de Bruxelles, Brussels.[29]Office of Research and Education, Canberra Health Services Library, Canberra, ACT, Australia.[30]School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia.[31]Division of Intensive Care Medicine, Department of Anesthesiology and Intensive Care, HUS Helsinki University Hospital, Helsinki.[32]Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.[33]Erasme University Hospital, Universite Libre de Bruxelles, Brussels.[34]Departamento de Clinica Medica-Emergencias Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo.[35]CareFlight Australia, Wentworthville, NSW, Australia.[36]Department ICU, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China.[37]Department of Critical Care Medicine, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing.[38]Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland.[39]Department of Clinical Care, University of Bern, Bern, Switzerland.[40]Faculty of Medicine and Health, University of New South Wales, Randwick, NSW, Australia.[41]School of Public Health, Imperial College London, London.
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.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.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).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.).
基金：
Funded by Australian National Health and Medical Research Council
(Project Grant number 632809); Canadian Institutes of Health Research
(RCT application number 154708); by an Investigator Grant (Leadership
Level 3 APP2017580) from National Health and Medical Research Council
of Australia (to Dr. Finfer); by an Emerging Leader Investigator Grant
from the National Health and Medical Research Council of Australia
APP1196320 (to Dr. Hammond); by a Chair in Knowledge Translation in
the ICU from the Canadian Institutes of Health Research (to Dr. Cook);
by “Programme d’Investissements d’Avenir” (PIA), reference ANR-18-
RHUS-0004, and French Ministry of Health Programme Hospitalier
de Recherche Clinique (PHRC), contract number PHRC-20-0778 (to
Dr. Annane).
语种：
外文
WOS：
PubmedID：
第一作者：
第一作者机构：[1]Critical Care Division, The George Institute for Global Health, Sydney.[2]Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.[3]Medical School, Faculty of Medical Sciences, University College London, London.[4]Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.
通讯作者：
通讯机构：[1]Critical Care Division, The George Institute for Global Health, Sydney.[40]Faculty of Medicine and Health, University of New South Wales, Randwick, NSW, Australia.[41]School of Public Health, Imperial College London, London.
推荐引用方式(GB/T 7714)：
Adigbli Derick,Li Yang,Hammond Naomi,et al.A Patient-Level Meta-Analysis of Intensive Glucose Control in Critically Ill Adults[J].NEJM Evidence.2024,3(8):EVIDoa2400082.doi:10.1056/EVIDoa2400082.
APA：
Adigbli Derick,Li Yang,Hammond Naomi,Chatoor Richard,Devaux Anthony G...&Finfer Simon.(2024).A Patient-Level Meta-Analysis of Intensive Glucose Control in Critically Ill Adults.NEJM Evidence,3,(8)
MLA：
Adigbli Derick,et al."A Patient-Level Meta-Analysis of Intensive Glucose Control in Critically Ill Adults".NEJM Evidence 3..8(2024):EVIDoa2400082
