Adigbli, Derick; Li, Yang; Hammond, Naomi; Chatoor, Richard; Devaux, Anthony G; Li, Qiang; Billot, Laurent; ... Finfer, Simon; + view all Adigbli, Derick; Li, Yang; Hammond, Naomi; Chatoor, Richard; Devaux, Anthony G; Li, Qiang; Billot, Laurent; Annane, Djillali; Arabi, Yaseen; Bilotta, Federico; Bohé, Julien; Brunkhorst, Frank Martin; Cavalcanti, Alexandre Biasi; Cook, Deborah; Engel, Christoph; Green-LaRoche, Deborah; He, Wei; Henderson, William; Hoedemaekers, Cornelia; Iapichino, Gaetano; Kalfon, Pierre; de La Rosa, Gisela; Lahooti, Afsaneh; Mackenzie, Iain; Mahendran, Sajeev; Mélot, Christian; Mitchell, Imogen; Oksanen, Tuomas; Polli, Federico; Preiser, Jean-Charles; Garcia Soriano, Francisco; Vlok, Ruan; Wang, Lingcong; Xu, Yuan; Delaney, Anthony P; Di Tanna, Gian Luca; Finfer, Simon; - view fewer (2024) A Patient-Level Meta-Analysis of Intensive Glucose Control in Critically Ill Adults. NEJM Evidence 10.1056/EVIDoa2400082. (In press).

Text Adigbli et al Glucoe IPDMA Accepted version.pdf - Accepted Version Download (742kB)

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.).

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