Does the achievement of an intermediate glycemic target reduce organ failure and mortality? A post hoc analysis of the Glucontrol trial

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• 作者：Sophie Penning ; MSc^a ; ^{Sophie.Penning@ulg.ac.be" class="auth_mail} ; J. Geoffrey Chase ; PhD^b ; ^{geoff.chase@canterbury.ac.nz" class="auth_mail} ; Jean-Charles Preiser ; PhD^c ; ^{Jean-Charles.Preiser@erasme.ulb.ac.be" class="auth_mail} ; Christopher G. Pretty ; PhD^b ; ^{chris.pretty@canterbury.ac.nz" class="auth_mail} ; Matthew Signal ; BE (Hons)^b ; ^{matthew.signal@pg.canterbury.ac.nz" class="auth_mail} ; Christian Mé ; lot ; MD ; PhD^d ; ^{cmelot@ulb.ac.be" class="auth_mail} ; Thomas Desaive ; PhD^a ; ^{tdesaive@ulg.ac.be" class="auth_mail}
• 关键词：Organ failure ; Glycemia ; Critically ill patients ; Intensive care ; Critical care ; Mortality
• 刊名：Journal of Critical Care
• 出版年：June 2014
• 年：2014
• 卷：29
• 期：3
• 页码：374-379
• 全文大小：362 K

文摘

This research evaluates the impact of the achievement of an intermediate target glycemic band on the severity of organ failure and mortality.

Methods

Daily Sequential Organ Failure Assessment (SOFA) score and the cumulative time in a 4.0 to 7.0 mmol/L band (cTIB) were evaluated daily up to 14 days in 704 participants of the multicentre Glucontrol trial (16 centers) that randomized patients to intensive group A (blood glucose [BG] target: 4.4-6.1 mmol/L) or conventional group B (BG target: 7.8-10.0 mmol/L). Sequential Organ Failure Assessment evolution was measured by percentage of patients with SOFA less than or equal to 5 on each day, percentage of individual organ failures, and percentage of organ failure–free days. Conditional and joint probability analysis of SOFA and cTIB 0.5 or more assessed the impact of achieving 4.0 to 7.0 mmol/L target glycemic range on organ failure. Odds ratios (OR) compare the odds risk of death for cTIB 0.5 or more vs cTIB less than 0.5, where a ratio greater than 1.0 indicates an improvement for achieving cTIB 0.5 or more independent of SOFA or glycemic target.

Results

Groups A and B were matched for demographic and severity of illness data. Blood glucose differed between groups A and B (P < .05), as expected. There was no difference in the percentage of patients with SOFA less than or equal to 5, individual organ failures, and organ failure–free days between groups A and B over days 1 to 14. However, 20% to 30% of group A patients failed to achieve cTIB 0.5 or more for all days, and significant crossover confounds interpretation. Mortality OR was greater than 1.0 for patients with cTIB 0.5 or more in both groups but much higher for group A on all days.

Conclusions

There was no difference in organ failure in the Glucontrol study based on intention to treat to different glycemic targets. Actual outcomes and significant crossover indicate that this result may not be due to the difference in target or treatment. Odds ratios–associated achieving an intermediate 4.0 to 7.0 mmol/L range improved outcome.