Intensive Insulin Therapy for Septic Patients : A Meta-Analysis of Randomized Controlled Trials

• Published in: BioMed research international Vol. 2014; no. 2014; pp. 1 - 10
• Main Authors: Zhong, Liu-Jun, Song, Fang, Han, Liang, Xie, Guo-Hao, Xiao, Cheng, Zhao, Bing, Hu, Yao-Qin, Wang, Shu-Yan, Qin, Chao-Jin, Zhang, Yan, Lai, Deng-Ming, Cui, Ping, Fang, Xiang-Ming
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Puplishing Corporation 01.01.2014; Hindawi Publishing Corporation; John Wiley & Sons, Inc; Hindawi Limited
• Subjects: Analysis; Care and treatment; Clinical trials; Diagnosis; Glucose; Health aspects; Hospitals; Humans; Hyperglycemia; Hyperglycemia - drug therapy; Hyperglycemia - mortality; Hyperglycemia - pathology; Hypoglycemia; Hypoglycemia - chemically induced; Hypoglycemia - pathology; Insulin; Insulin - adverse effects; Insulin - therapeutic use; Intensive Care Units; Metabolism; Mortality; Patient outcomes; Physiological aspects; PubMed; Randomized Controlled Trials as Topic; Review; Studies; Treatment Outcome; United States
• ISSN: 2314-6133; 2314-6141
• DOI: 10.1155/2014/698265

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.