ABSTRACT
Anastassios
G. Pittas, MD; Richard D. Siegel, MD; Joseph Lau, MD
Background: Hyperglycemia is common in critically ill hospitalized patients,
and it is associated with adverse outcomes, including increased mortality. The
objective of
this meta-analysis was to determine the effect
of insulin therapy initiated during hospitalization on mortality in adult
patients with a critical illness.
Methods: An electronic search in the Englishlanguage articles of MEDLINE
and the Cochrane Controlled Clinical Trials Register and a hand search of key journals
and relevant review articles were performed. Randomized controlled trials that
reported mortality data on critically ill hospitalized adult patients who were
treated
with insulin were selected. Data on patient
demographics, hospital setting, intervention (formulation and dosage of
insulin, delivery method, and duration of therapy), mortality outcomes, adverse
events, and methodological quality were extracted.
Results: Thirty-five trials met the inclusion criteria. Combining data
from all trials using a random-effects model showed that insulin therapy
decreases short-term mortality by 15% (relative risk [RR], 0.85; 95% confidence
interval [CI], 0.75-0.97). In subgroup analyses, insulin therapy decreased
mortality in the surgical intensive care unit (RR, 0.58; 95% CI, 0.22-0.62),
when the aim of therapy was glucose control (RR, 0.71; 95% CI, 0.54-0.93), and
in patients with diabetes mellitus (RR, 0.73; 95% CI, 0.58-0.90). A
near-significant trend toward decreasing mortality was seen in patients with acute
myocardial infarction who did not receive reperfusion therapy (RR, 0.84; 95%
CI, 0.71-1.00). No randomized trials of insulin in the medical intensive care unit
were identified.
Conclusion: Insulin therapy initiated in the hospital in critically ill
patients has a beneficial effect on shortterm mortality in different clinical
settings.
(Arch Intern Med. 2004;164:2005-2011)
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