Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
Department of Emergency and Critical Care Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-cho, Hachioji, Tokyo, 192-0032, Japan.
Intensive Care Med. 2017 Jan;43(1):16-28. doi: 10.1007/s00134-016-4558-2. Epub 2016 Sep 29.
The optimal target blood glucose concentration for acute glycemic control remains unclear because few studies have directly compared 144-180 with 110-144 or >180 mg/dL. Accordingly, we performed a network meta-analysis to compare four different target blood glucose levels (<110, 110-144, 144-180, and >180 mg/dL) in terms of the benefit and risk of insulin therapy.
We included all of the studies from three systematic reviews and searched the PubMed and Cochrane databases for other studies investigating glucose targets among critically ill patients. The primary outcome was hospital mortality, and the secondary outcomes were sepsis or bloodstream infection and the risk of hypoglycemia. Network meta-analysis to identify an optimal target glucose concentration.
The network meta-analysis included 18,098 patients from 35 studies. There were no significant differences in the risk of mortality and infection among the four blood glucose ranges overall or in subgroup analysis. Conversely, target concentrations of <110 and 110-144 mg/dL were associated with a four to ninefold increase in the risk of hypoglycemia compared with 144-180 and >180 mg/dL. However, there were no significant differences between the target concentrations of 144-180 and >180 mg/dL.
This network meta-analysis found no significant difference in the risk of mortality and infection among four target blood glucose ranges in critically ill patients, but indicated that target blood glucose levels of <110 and 110-144 mg/dL were associated with a higher risk of hypoglycemia than target levels of 144-180 and >180 mg/dL. Further studies are required to refute or confirm our findings.
急性血糖控制的最佳目标血糖浓度仍不清楚，因为很少有研究直接比较 144-180 与 110-144 或 >180mg/dL。因此，我们进行了一项网络荟萃分析，比较了四种不同的目标血糖水平（<110、110-144、144-180 和 >180mg/dL）在胰岛素治疗的获益和风险方面。
我们纳入了三项系统评价中的所有研究，并在 PubMed 和 Cochrane 数据库中搜索了其他研究危重病患者血糖目标的研究。主要结局为住院死亡率，次要结局为脓毒症或血流感染以及低血糖风险。网络荟萃分析确定最佳目标血糖浓度。
网络荟萃分析纳入了来自 35 项研究的 18098 例患者。总体或亚组分析中，四个血糖范围的死亡率和感染风险无显著差异。相反，与 144-180 和 >180mg/dL 相比，<110 和 110-144mg/dL 的目标浓度与低血糖风险增加 4 至 9 倍相关。然而，144-180 和 >180mg/dL 之间的目标浓度没有显著差异。
本网络荟萃分析发现，危重病患者四个目标血糖范围的死亡率和感染风险无显著差异，但表明<110 和 110-144mg/dL 的目标血糖水平与低血糖风险高于 144-180 和 >180mg/dL 的目标血糖水平相关。需要进一步的研究来反驳或证实我们的发现。
