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dc.contributor.authorHermanides, Jeroenen
dc.contributor.authorPlummer, Mark Pen
dc.contributor.authorFinnis, Marken
dc.contributor.authorDeane, Adam Men
dc.contributor.authorColes, Jonathanen
dc.contributor.authorMenon, Daviden
dc.date.accessioned2018-01-29T09:28:31Z
dc.date.available2018-01-29T09:28:31Z
dc.date.issued2018-01-19en
dc.identifier.issn1364-8535
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/271232
dc.description.abstractBackground Optimal glycaemic targets in traumatic brain injury (TBI) remain unclear. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing intensive with conventional glycaemic control in TBI requiring admission to an intensive care unit (ICU). Methods We systematically searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials to November 2016. Outcomes of interest included ICU and in-hospital mortality, poor neurological outcome, the incidence of hypoglycaemia, and infective complications. Data were analysed by pairwise random effects models with secondary analysis of differing levels of conventional glycaemic control. Results Ten RCTs, involving 1066 TBI patients were included. Three studies were conducted exclusively in a TBI population, whereas in seven trials, the TBI population was a sub-cohort of a mixed neurocritical or general ICU population. Glycaemic targets with intensive control ranged from 4.4–6.7 mmol/L, while conventional targets aimed to keep glucose levels below thresholds of 8.4–12 mmol/L. Conventional versus intensive control showed no association with ICU or hospital mortality, RR (95%CI) 0.93(0.68-1.27), P=0.64 and 1.07(0.84-1.36), P=0.62 respectively. The risk of a poor neurological outcome was higher with conventional control (RR (95%CI) = 1.10(1.001-1.24), P= 0.047. However, severe hypoglycaemia occurred less frequently with conventional control, RR (95%CI) = 0.22(0.09-0.52), P=0.001. Conclusions This meta-analysis of intensive glycaemic control shows no association with improved mortality in TBI. Intensive glucose control showed a borderline significant reduction in the risk of poor neurological outcome, but markedly increased the risk of hypoglycaemia. These contradictory findings should motivate further research.
dc.format.mediumElectronicen
dc.languageengen
dc.publisherBioMed Central
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectHumansen
dc.subjectHyperglycemiaen
dc.subjectHypoglycemiaen
dc.subjectDiabetes Complicationsen
dc.subjectBlood Glucoseen
dc.subjectHypoglycemic Agentsen
dc.subjectHospital Mortalityen
dc.subjectGlycemic Indexen
dc.subjectIntensive Care Unitsen
dc.subjectBrain Injuries, Traumaticen
dc.subjectGlycated Hemoglobin Aen
dc.titleGlycaemic control targets after traumatic brain injury: a systematic review and meta-analysis.en
dc.typeArticle
prism.issueIdentifier1en
prism.publicationDate2018en
prism.publicationNameCritical care (London, England)en
prism.startingPage11
prism.volume22en
dc.identifier.doi10.17863/CAM.18213
dcterms.dateAccepted2017-10-31en
rioxxterms.versionofrecord10.1186/s13054-017-1883-yen
rioxxterms.versionVoR*
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/en
rioxxterms.licenseref.startdate2018-01-19en
dc.contributor.orcidHermanides, Jeroen [0000-0003-2239-1260]
dc.contributor.orcidPlummer, Mark P [0000-0002-9640-1911]
dc.contributor.orcidDeane, Adam M [0000-0002-7620-5577]
dc.contributor.orcidColes, Jonathan [0000-0003-4013-679X]
dc.contributor.orcidMenon, David [0000-0002-3228-9692]
dc.identifier.eissn1466-609X
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idDepartment of Health (via National Institute for Health Research (NIHR)) (unknown)
pubs.funder-project-idEuropean Commission Horizon 2020 (H2020) Marie Sk?odowska-Curie actions (656690)
pubs.funder-project-idMRC (G0600986)
cam.orpheus.successThu Jan 30 13:00:32 GMT 2020 - The item has an open VoR version.*
rioxxterms.freetoread.startdate2100-01-01


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International