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
François Thouy,
Julien Bohé,
Bertrand Souweine,
Hassane Abidi,
Jean-Pierre Quenot,
Fabrice Thiollière,
Jean Dellamonica,
Jean-Charles Preiser,
Jean-François Timsit,
Vincent Brunot,
Amna Klich,
Nicholas Sedillot,
Xavier Tchenio,
Jean-Baptiste Roudaut,
Nicolas Mottard,
Hervé Hyvernat,
Florent Wallet,
Pierre-Eric Danin,
Julio Badie,
Richard Jospe,
Jérôme Morel,
Ali Mofredj,
Abdelhamid Fatah,
Jocelyne Drai,
Anne Mialon,
Ali Ait Hssain,
Alexandre Lautrette,
Eric Fontaine,
Charles-Hervé Vacheron,
Delphine Maucort-Boulch,
Kada Klouche,
Claire Dupuis
Affiliations
François Thouy
Service de Médecine Intensive Réanimation, CHU Hôpital Gabriel-Montpied
Julien Bohé
Service d’Anesthésie-Réanimation-Médecine Intensive, Groupement hospitalier sud, Hospices Civils de Lyon
Bertrand Souweine
Service de Médecine Intensive Réanimation, CHU Hôpital Gabriel-Montpied
Hassane Abidi
Service d’Anesthésie-Réanimation-Médecine Intensive, Groupement hospitalier sud, Hospices Civils de Lyon
Jean-Pierre Quenot
Service de Médecine Intensive Réanimation, CHU Dijon Bourgogne
Fabrice Thiollière
Service d’Anesthésie-Réanimation-Médecine Intensive, Groupement hospitalier sud, Hospices Civils de Lyon
Jean Dellamonica
Service de Médecine Intensive Réanimation, CHU Hôpital de L’Archet
Jean-Charles Preiser
Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles
Jean-François Timsit
Service de Réanimation Médicale et des Maladies Infectieuses, Université Paris Diderot/Hôpital Bichat, Assistance Publique Hôpitaux de Paris
Vincent Brunot
Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire
Amna Klich
Service de Biostatistique - Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon
Nicholas Sedillot
Service de Réanimation, Hôpital Fleyriat
Xavier Tchenio
Service de Réanimation, Hôpital Fleyriat
Jean-Baptiste Roudaut
Service de Médecine Intensive Réanimation, CHU Dijon Bourgogne
Nicolas Mottard
Service d’Anesthésie-Réanimation-Médecine Intensive, Groupement hospitalier sud, Hospices Civils de Lyon
Hervé Hyvernat
Service de Médecine Intensive Réanimation, CHU Hôpital de L’Archet
Florent Wallet
Service d’Anesthésie-Réanimation-Médecine Intensive, Groupement hospitalier sud, Hospices Civils de Lyon
Pierre-Eric Danin
Service de Réanimation Médico-Chirurgicale, CHU Hôpital de L’Archet
Julio Badie
Service de Réanimation Médico-Chirurgicale, CHU Hôpital de L’Archet
Richard Jospe
Département d’Anesthésie et Réanimation, CHU
Jérôme Morel
Département d’Anesthésie et Réanimation, CHU
Ali Mofredj
Service de Réanimation, Hôpital du pays Salonais
Abdelhamid Fatah
Service de Réanimation, Hôpital Pierre Oudot
Jocelyne Drai
Laboratoire de Biochimie, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon
Anne Mialon
Laboratoire de Biochimie, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon
Ali Ait Hssain
Service de Médecine Intensive Réanimation, CHU Hôpital Gabriel-Montpied
Alexandre Lautrette
Département d’Anesthésie et Réanimation, Centre Jean Perrin
Eric Fontaine
INSERM U1055 - LBFA, University Grenoble Alpes
Charles-Hervé Vacheron
Service d’Anesthésie-Réanimation-Médecine Intensive, Groupement hospitalier sud, Hospices Civils de Lyon
Delphine Maucort-Boulch
Service de Biostatistique - Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon
Kada Klouche
Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire
Claire Dupuis
Service de Médecine Intensive Réanimation, CHU Hôpital Gabriel-Montpied
Abstract 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 (IPTWHR = 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 (IPTWHR = 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.
