Endocrine Abstracts

Background: Acute stroke, traumatic brain injury, and subarachnoid hemorrhage are common diagnoses of patients in Critical Care Units, which often lead to increased morbidity and mortality. Patients with brain damage experience wide glucose fluctuation, with episodes of hyperglycemia. Hyperglycemia has traditionally been associated with poor clinical outcomes after brain injury.

Objectives: To evaluate the effects of intensive versus conventional glucose control in mortality as well as the incidence of glucose disturbances and the neurologic outcome in critically ill brain injured adults.

Search methods: We performed a meta-analysis after systematically searching PubMed, and Scopus databases to retrieve RCTs in English. We initially retrieved 3081 citations. After removing duplicates, animal, pediatric, and studies including non ICU patients, eleven studies remained and were analyzed with Review Manager ver 5.1. Odds ratios (OR) or Peto Odds ratios (POR) with 95% confidence intervals (CI) were calculated.

Results: In critically ill adult patients, both in-hospital mortality, OR 1.05 (M-H, Fixed, 95%, CI 0.60, 1.85) and overall mortality, OR 1.09 (M-H, Fixed, 95% CI 0.88, 1.34) do not show any statistically significant difference (P=0.86 and P=0.44 respectively) in the two different strategies. Furthermore, no statistically significant difference occurred in neurologic outcome, OR 0.90 (M-H, Fixed, 95% CI 0.65, 1.24) P=0.51. However, there was a statistically significant difference in hypoglycemic episodes, POR 6.71 (P-Fixed, 95% CI 5.14, 8.75) P<0.00001, implying that aggressive treatment for lowering blood glucose may have deleterious effects.

Conclusions: Critically ill brain injured adult patients have more hypoglycemic events with intensive glucose control without neurological or survival benefit. Hypoglycemic events are not risk free and a tighter glucose control is not justified with the available data.