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Impact of prolonged requirement for insulin on 90-day mortality in critically ill patients without previous diabetic treatments: a post hoc analysis of the CONTROLING randomized control trial
BACKGROUND: Stress hyperglycemia can persist during an intensive care unit (ICU) stay and result in prolonged requirement for insulin (PRI). The impact of PRI on ICU patient outcomes is not known. We evaluated the relationship between PRI and Day 90 mortality in ICU patients without previous diabeti...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9109308/ https://www.ncbi.nlm.nih.gov/pubmed/35578303 http://dx.doi.org/10.1186/s13054-022-04004-1 |
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author | Thouy, François Bohé, Julien Souweine, Bertrand Abidi, Hassane Quenot, Jean-Pierre Thiollière, Fabrice Dellamonica, Jean Preiser, Jean-Charles Timsit, Jean-François Brunot, Vincent Klich, Amna Sedillot, Nicholas Tchenio, Xavier Roudaut, Jean-Baptiste Mottard, Nicolas Hyvernat, Hervé Wallet, Florent Danin, Pierre-Eric Badie, Julio Jospe, Richard Morel, Jérôme Mofredj, Ali Fatah, Abdelhamid Drai, Jocelyne Mialon, Anne Ait Hssain, Ali Lautrette, Alexandre Fontaine, Eric Vacheron, Charles-Hervé Maucort-Boulch, Delphine Klouche, Kada Dupuis, Claire |
author_facet | Thouy, François Bohé, Julien Souweine, Bertrand Abidi, Hassane Quenot, Jean-Pierre Thiollière, Fabrice Dellamonica, Jean Preiser, Jean-Charles Timsit, Jean-François Brunot, Vincent Klich, Amna Sedillot, Nicholas Tchenio, Xavier Roudaut, Jean-Baptiste Mottard, Nicolas Hyvernat, Hervé Wallet, Florent Danin, Pierre-Eric Badie, Julio Jospe, Richard Morel, Jérôme Mofredj, Ali Fatah, Abdelhamid Drai, Jocelyne Mialon, Anne Ait Hssain, Ali Lautrette, Alexandre Fontaine, Eric Vacheron, Charles-Hervé Maucort-Boulch, Delphine Klouche, Kada Dupuis, Claire |
author_sort | Thouy, François |
collection | PubMed |
description | BACKGROUND: Stress hyperglycemia can persist during an intensive care unit (ICU) stay and result in prolonged requirement for insulin (PRI). The impact of PRI on ICU patient outcomes is not known. We evaluated the relationship between PRI and Day 90 mortality in ICU patients without previous diabetic treatments. METHODS: This is a post hoc analysis of the CONTROLING trial, involving 12 French ICUs. Patients in the personalized glucose control arm with an ICU length of stay ≥ 5 days and who had never previously received diabetic treatments (oral drugs or insulin) were included. Personalized blood glucose targets were estimated on their preadmission usual glycemia as estimated by their glycated A1c hemoglobin (HbA1C). PRI was defined by insulin requirement. The relationship between PRI on Day 5 and 90-day mortality was assessed by Cox survival models with inverse probability of treatment weighting (IPTW). Glycemic control was defined as at least one blood glucose value below the blood glucose target value on Day 5. RESULTS: A total of 476 patients were included, of whom 62.4% were male, with a median age of 66 (54–76) years. Median values for SAPS II and HbA1C were 50 (37.5–64) and 5.7 (5.4–6.1)%, respectively. PRI was observed in 364/476 (72.5%) patients on Day 5. 90-day mortality was 23.1% in the whole cohort, 25.3% in the PRI group and 16.1% in the non-PRI group (p < 0.01). IPTW analysis showed that PRI on Day 5 was not associated with Day 90 mortality ((IPTW)HR = 1.22; CI 95% 0.84–1.75; p = 0.29), whereas PRI without glycemic control was associated with an increased risk of death at Day 90 ((IPTW)HR = 3.34; CI 95% 1.26–8.83; p < 0.01). CONCLUSION: In ICU patients without previous diabetic treatments, only PRI without glycemic control on Day 5 was associated with an increased risk of death. Additional studies are required to determine the factors contributing to these results. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-04004-1. |
format | Online Article Text |
id | pubmed-9109308 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-91093082022-05-17 Impact of prolonged requirement for insulin on 90-day mortality in critically ill patients without previous diabetic treatments: a post hoc analysis of the CONTROLING randomized control trial Thouy, François Bohé, Julien Souweine, Bertrand Abidi, Hassane Quenot, Jean-Pierre Thiollière, Fabrice Dellamonica, Jean Preiser, Jean-Charles Timsit, Jean-François Brunot, Vincent Klich, Amna Sedillot, Nicholas Tchenio, Xavier Roudaut, Jean-Baptiste Mottard, Nicolas Hyvernat, Hervé Wallet, Florent Danin, Pierre-Eric Badie, Julio Jospe, Richard Morel, Jérôme Mofredj, Ali Fatah, Abdelhamid Drai, Jocelyne Mialon, Anne Ait Hssain, Ali Lautrette, Alexandre Fontaine, Eric Vacheron, Charles-Hervé Maucort-Boulch, Delphine Klouche, Kada Dupuis, Claire Crit Care Research BACKGROUND: Stress hyperglycemia can persist during an intensive care unit (ICU) stay and result in prolonged requirement for insulin (PRI). The impact of PRI on ICU patient outcomes is not known. We evaluated the relationship between PRI and Day 90 mortality in ICU patients without previous diabetic treatments. METHODS: This is a post hoc analysis of the CONTROLING trial, involving 12 French ICUs. Patients in the personalized glucose control arm with an ICU length of stay ≥ 5 days and who had never previously received diabetic treatments (oral drugs or insulin) were included. Personalized blood glucose targets were estimated on their preadmission usual glycemia as estimated by their glycated A1c hemoglobin (HbA1C). PRI was defined by insulin requirement. The relationship between PRI on Day 5 and 90-day mortality was assessed by Cox survival models with inverse probability of treatment weighting (IPTW). Glycemic control was defined as at least one blood glucose value below the blood glucose target value on Day 5. RESULTS: A total of 476 patients were included, of whom 62.4% were male, with a median age of 66 (54–76) years. Median values for SAPS II and HbA1C were 50 (37.5–64) and 5.7 (5.4–6.1)%, respectively. PRI was observed in 364/476 (72.5%) patients on Day 5. 90-day mortality was 23.1% in the whole cohort, 25.3% in the PRI group and 16.1% in the non-PRI group (p < 0.01). IPTW analysis showed that PRI on Day 5 was not associated with Day 90 mortality ((IPTW)HR = 1.22; CI 95% 0.84–1.75; p = 0.29), whereas PRI without glycemic control was associated with an increased risk of death at Day 90 ((IPTW)HR = 3.34; CI 95% 1.26–8.83; p < 0.01). CONCLUSION: In ICU patients without previous diabetic treatments, only PRI without glycemic control on Day 5 was associated with an increased risk of death. Additional studies are required to determine the factors contributing to these results. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-04004-1. BioMed Central 2022-05-16 /pmc/articles/PMC9109308/ /pubmed/35578303 http://dx.doi.org/10.1186/s13054-022-04004-1 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Thouy, François Bohé, Julien Souweine, Bertrand Abidi, Hassane Quenot, Jean-Pierre Thiollière, Fabrice Dellamonica, Jean Preiser, Jean-Charles Timsit, Jean-François Brunot, Vincent Klich, Amna Sedillot, Nicholas Tchenio, Xavier Roudaut, Jean-Baptiste Mottard, Nicolas Hyvernat, Hervé Wallet, Florent Danin, Pierre-Eric Badie, Julio Jospe, Richard Morel, Jérôme Mofredj, Ali Fatah, Abdelhamid Drai, Jocelyne Mialon, Anne Ait Hssain, Ali Lautrette, Alexandre Fontaine, Eric Vacheron, Charles-Hervé Maucort-Boulch, Delphine Klouche, Kada Dupuis, Claire Impact of prolonged requirement for insulin on 90-day mortality in critically ill patients without previous diabetic treatments: a post hoc analysis of the CONTROLING randomized control trial |
title | Impact of prolonged requirement for insulin on 90-day mortality in critically ill patients without previous diabetic treatments: a post hoc analysis of the CONTROLING randomized control trial |
title_full | Impact of prolonged requirement for insulin on 90-day mortality in critically ill patients without previous diabetic treatments: a post hoc analysis of the CONTROLING randomized control trial |
title_fullStr | Impact of prolonged requirement for insulin on 90-day mortality in critically ill patients without previous diabetic treatments: a post hoc analysis of the CONTROLING randomized control trial |
title_full_unstemmed | Impact of prolonged requirement for insulin on 90-day mortality in critically ill patients without previous diabetic treatments: a post hoc analysis of the CONTROLING randomized control trial |
title_short | Impact of prolonged requirement for insulin on 90-day mortality in critically ill patients without previous diabetic treatments: a post hoc analysis of the CONTROLING randomized control trial |
title_sort | impact of prolonged requirement for insulin on 90-day mortality in critically ill patients without previous diabetic treatments: a post hoc analysis of the controling randomized control trial |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9109308/ https://www.ncbi.nlm.nih.gov/pubmed/35578303 http://dx.doi.org/10.1186/s13054-022-04004-1 |
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