Abstract
ObjectiveTo evaluate the benefits and risks of tight glycemia control (TGC) versus conventional glucose control (CGC) in critically ill brain injured adults. MethodsWe performed meta-analysis by systematically searching PubMed, EMBASE, OVID, ScienceDirect, Web of Science, CNKI, Wanfang Data, and CQVIP databases to retrieve RCTs in any languages. We used Review Manager to perform meta-analysis. Odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated in analyses. ResultsTwenty six RCTs with a total of 3,759 participants were included in this meta-analysis. In-hospital mortality showed significant dissimilarity between TGC and CGC groups with OR of 0.76 (95% CI 0.58, 0.99). However, in terms of overall mortality and long term neurological severity outcome, it didn't show differences with ORs of 0.93 (95% CI 0.79, 1.10) and 1.15 (95% CI 0.96, 1.37). There were also discrepancies in infection rate and ICU length of stay (LOS) with OR of 0.51 (95% CI 0.42, 0.62) and WMD of −2.37 (95% CI −2.99, −1.74). Significances were observed in hypoglycemia events with ORs of 6.24 (95% CI 4.83, 8.07) and 2.73 (95% CI 2.56, 2.91) using two methods. ConclusionIn critically ill brain injury, TGC did not show beneficial effects on reducing overall mortality and long term neurological outcome, but it increased the risk of hypoglycemia.
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