Organ failure and tight glycemic control in the SPRINT study.

[en] INTRODUCTION: Intensive care unit mortality is strongly associated with organ failure rate and severity. The sequential organ failure assessment (SOFA) score is used to evaluate the impact of a successful tight glycemic control (TGC) intervention (SPRINT) on organ failure, morbidity, and thus mortality. METHODS: A retrospective analysis of 371 patients (3,356 days) on SPRINT (August 2005 - April 2007) and 413 retrospective patients (3,211 days) from two years prior, matched by Acute Physiology and Chronic Health Evaluation (APACHE) III. SOFA is calculated daily for each patient. The effect of the SPRINT TGC intervention is assessed by comparing the percentage of patients with SOFA </=5 each day and its trends over time and cohort/group. Organ-failure free days (all SOFA components </=2) and number of organ failures (SOFA components >2) are also compared. Cumulative time in 4.0 to 7.0 mmol/L band (cTIB) was evaluated daily to link tightness and consistency of TGC (cTIB >/=0.5) to SOFA </=5 using conditional and joint probabilities. RESULTS: Admission and maximum SOFA scores were similar (P = 0.20; P = 0.76), with similar time to maximum (median: one day; IQR: 13 days; P = 0.99). Median length of stay was similar (4.1 days SPRINT and 3.8 days Pre-SPRINT; P = 0.94). The percentage of patients with SOFA </=5 is different over the first 14 days (P = 0.016), rising to approximately 75% for Pre-SPRINT and approximately 85% for SPRINT, with clear separation after two days. Organ-failure-free days were different (SPRINT = 41.6%; Pre-SPRINT = 36.5%; P < 0.0001) as were the percent of total possible organ failures (SPRINT = 16.0%; Pre-SPRINT = 19.0%; P < 0.0001). By Day 3 over 90% of SPRINT patients had cTIB >/=0.5 (37% Pre-SPRINT) reaching 100% by Day 7 (50% Pre-SPRINT). Conditional and joint probabilities indicate tighter, more consistent TGC under SPRINT (cTIB >/=0.5) increased the likelihood SOFA </=5. CONCLUSIONS: SPRINT TGC resolved organ failure faster, and for more patients, from similar admission and maximum SOFA scores, than conventional control. These reductions mirror the reduced mortality with SPRINT. The cTIB >/=0.5 metric provides a first benchmark linking TGC quality to organ failure. These results support other physiological and clinical results indicating the role tight, consistent TGC can play in reducing organ failure, morbidity and mortality, and should be validated on data from randomised trials.

Disciplines :

Anesthesia & intensive care

Author, co-author :

Chase, J Geoffrey

Pretty, Christopher G

Pfeifer, Leesa

Shaw, Geoffrey M

Preiser, Jean-Charles ; Centre Hospitalier Universitaire de Liège - CHU > Soins intensifs

Le Compte, Aaron J

Lin, Jessica

Hewett, Darren

Moorhead, Katherine ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Biochimie et physiologie générales, humaines et path. - Thermodynamique des phénomènes irréversibles

Desaive, Thomas ; Université de Liège - ULiège > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles - Département d'astrophys., géophysique et océanographie (AGO)

Language :

English

Title :

Organ failure and tight glycemic control in the SPRINT study.

Publication date :

2010

Journal title :

Critical Care

ISSN :

1364-8535

eISSN :

1466-609X

Publisher :

BioMed Central, London, United Kingdom

Volume :

Issue :

Pages :

R154

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 28 November 2010

Statistics

Number of views

78 (6 by ULiège)

Number of downloads

134 (1 by ULiège)

More statistics

Scopus citations^®

103

Scopus citations^®
without self-citations

OpenCitations

Bibliography

Messahel FM, Seraj MA. Mortality in the surgical intensive care unit--the role of sepsis and organ failure. Middle East J Anesthesiol 1989, 10:299-305.
Tran DD, Groeneveld AB, van der Meulen J, Nauta JJ, Strack van Schijndel RJ, Thijs LG. Age, chronic disease, sepsis, organ system failure, and mortality in a medical intensive care unit. Crit Care Med 1990, 18:474-479. 10.1097/00003246-199005000-00002, 2328591.
Sakr Y, Vincent JL, Ruokonen E, Pizzamiglio M, Installe E, Reinhart K, Moreno R. Sepsis and organ system failure are major determinants of post-intensive care unit mortality. Journal of Critical Care 2008, 23:475-483. 10.1016/j.jcrc.2007.09.006, 19056010.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996, 22:707-710. 10.1007/BF01709751, 8844239.
Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med 1998, 26:1793-1800.
Vincent JL. Organ dysfunction in patients with severe sepsis. Surg Infect (Larchmt) 2006, 7(Suppl 2):S69-72.
Ellger B, Richir MC, van Leeuwen PA, Debaveye Y, Langouche L, Vanhorebeek I, Teerlink T, Van den Berghe G. Glycemic control modulates arginine and asymmetrical-dimethylarginine levels during critical illness by preserving dimethylarginine-dimethylaminohydrolase activity. Endocrinology 2008, 149:3148-3157. 10.1210/en.2007-1558, 18292189.
Van den Berghe G. How does blood glucose control with insulin save lives in intensive care?. J Clin Invest 2004, 114:1187-1195. 524243, 15520847.
Langouche L, Meersseman W, Vander Perre S, Milants I, Wouters PJ, Hermans G, Gjedsted J, Hansen TK, Arnout J, Wilmer A, Schetz M, Van den Berghe G. Effect of insulin therapy on coagulation and fibrinolysis in medical intensive care patients. Crit Care Med 2008, 36:1475-1480. 10.1097/CCM.0b013e31816f7bae, 18434900.
Koch A, Gressner OA, Sanson E, Tacke F, Trautwein C. Serum resistin levels in critically ill patients are associated with inflammation, organ dysfunction and metabolism and may predict survival of non-septic patients. Crit Care 2009, 13:R95. 10.1186/cc7925, 2717467, 19545363.
Egi M, Bellomo R, Stachowski E, French CJ, Hart G. Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology 2006, 105:244-252. 10.1097/00000542-200608000-00006, 16871057.
Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc 2003, 78:1471-1478. 10.4065/78.12.1471, 14661676.
Waeschle RM, Moerer O, Hilgers R, Herrmann P, Neumann P, Quintel M. The impact of the severity of sepsis on the risk of hypoglycaemia and glycaemic variability. Critical Care (London, England) 2008, 12:R129. 10.1186/cc7097, 2592768, 18939991.
Bagshaw SM, Bellomo R, Jacka MJ, Egi M, Hart GK, George C. The impact of early hypoglycemia and blood glucose variability on outcome in critical illness. Crit Care 2009, 13:R91. 10.1186/cc7921, 2717463, 19534781.
Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature 2001, 414:813-820. 10.1038/414813a, 11742414.
Dandona P, Mohanty P, Chaudhuri A, Garg R, Aljada A. Insulin infusion in acute illness. The Journal of Clinical Investigation 2005, 115:2069-2072. 10.1172/JCI26045, 1180564, 16075050.
Langouche L, Vanhorebeek I, Vlasselaers D, Vander Perre S, Wouters PJ, Skogstrand K, Hansen TK, Van den Berghe G. Intensive insulin therapy protects the endothelium of critically ill patients. J Clin Invest 2005, 115:2277-2286. 10.1172/JCI25385, 1180545, 16075063.
Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001, 345:1359-1367. 10.1056/NEJMoa011300, 11794168.
Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, Van Wijngaerden E, Bobbaers H, Bouillon R. Intensive insulin therapy in the medical ICU. N Engl J Med 2006, 354:449-461. 10.1056/NEJMoa052521, 16452557.
Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc 2004, 79:992-1000. 10.4065/79.8.992, 15301325.
Chase JG, Shaw G, Le Compte A, Lonergan T, Willacy M, Wong XW, Lin J, Lotz T, Lee D, Hann C. Implementation and evaluation of the SPRINT protocol for tight glycaemic control in critically ill patients: a clinical practice change. Crit Care 2008, 12:R49. 10.1186/cc6868, 2447603, 18412978.
Weekers F, Giulietti AP, Michalaki M, Coopmans W, Van Herck E, Mathieu C, Van den Berghe G. Metabolic, endocrine, and immune effects of stress hyperglycemia in a rabbit model of prolonged critical illness. Endocrinology 2003, 144:5329-5338. 10.1210/en.2003-0697, 12960028.
Yu WK, Li WQ, Wang XD, Yan XW, Qi XP, Li N, Li JS. [Influence and mechanism of a tight control of blood glucose by intensive insulin therapy on human sepsis]. Zhonghua Wai Ke Za Zhi 2005, 43:29-32.
Langouche L, Vanhorebeek I, Van den Berghe G. The role of insulin therapy in critically ill patients. Treat Endocrinol 2005, 4:353-360. 10.2165/00024677-200504060-00004, 16318401.
Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson WR, Hébert PC, Heritier S, Heyland DK, McArthur C, McDonald E, Mitchell I, Myburgh JA, Norton R, Potter J, Robinson BG, Ronco JJ. NICE-SUGAR Study Investigators Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009, 360:1283-1297. 10.1056/NEJMoa0810625, 19318384, NICE-SUGAR Study Investigators.
Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K, . German Competence Network Sepsis (sepnet) Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008, 358:125-139. 10.1056/NEJMoa070716, 18184958, German Competence Network Sepsis (sepnet).
Preiser JC, Devos P, Ruiz-Santana S, Mélot C, Annane D, Groeneveld J, Iapichino G, Leverve X, Nitenberg G, Singer P, Wernerman J, Joannidis M, Stecher A, Chioléro R. A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. Intensive Care Med 2009, 35:1738-1748. 10.1007/s00134-009-1585-2, 19636533.
Lonergan T, Le Compte A, Willacy M, Chase JG, Shaw GM, Wong XW, Lotz T, Lin J, Hann CE. A simple insulin-nutrition protocol for tight glycemic control in critical illness: development and protocol comparison. Diabetes Technol Ther 2006, 8:191-206. 10.1089/dia.2006.8.191, 16734549.
Lonergan T, Compte AL, Willacy M, Chase JG, Shaw GM, Hann CE, Lotz T, Lin J, Wong XW. A pilot study of the SPRINT protocol for tight glycemic control in critically Ill patients. Diabetes Technol Ther 2006, 8:449-462. 10.1089/dia.2006.8.449, 16939370.
Wong XW, Singh-Levett I, Hollingsworth LJ, Shaw GM, Hann CE, Lotz T, Lin J, Wong OS, Chase JG. A novel, model-based insulin and nutrition delivery controller for glycemic regulation in critically ill patients. Diabetes Technol Ther 2006, 8:174-190. 10.1089/dia.2006.8.174, 16734548.
Chase JG, Shaw GM, Lin J, Doran CV, Hann C, Lotz T, Wake GC, Broughton B. Targeted glycemic reduction in critical care using closed-loop control. Diabetes Technol Ther 2005, 7:274-282. 10.1089/dia.2005.7.274, 15857229.
Chase JG, Shaw GM, Lotz T, Le Compte A, Wong J, Lin J, Lonergan T, Willacy M, Hann CE. Model-based insulin and nutrition administration for tight glycaemic control in critical care. Curr Drug Deliv 2007, 4:283-296. 10.2174/156720107782151223, 17979649.
Suhaimi F, Le Compte A, Preiser JC, Shaw GM, Massion P, Radermecker R, Pretty C, Lin J, Desaive T, Chase JG. What makes tight glycemic control (TGC) tight? The impact of variability and nutrition in 2 clinical studies. Journal of Diabetes Science and Technology 2010, 4:284-298.
Meijering S, Corstjens AM, Tulleken JE, Meertens JH, Zijlstra JG, Ligtenberg JJ. Towards a feasible algorithm for tight glycaemic control in critically ill patients: a systematic review of the literature. Crit Care 2006, 10:R19. 10.1186/cc3981, 1550808, 16469124.
Marik PE, Preiser JC. Toward understanding tight glycemic control in the ICU: a systematic review and metaanalysis. Chest 137:544-551. 10.1378/chest.09-1737, 20018803.
Cerra FB, Benitez MR, Blackburn GL, Irwin RS, Jeejeebhoy K, Katz DP, Pingleton SK, Pomposelli J, Rombeau JL, Shronts E, Wolfe RR, Zaloga GP. Applied nutrition in ICU patients. A consensus statement of the American College of Chest Physicians. Chest 1997, 111:769-778. 10.1378/chest.111.3.769, 9118718.
Krishnan JA, Parce PB, Martinez A, Diette GB, Brower RG. Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes. Chest 2003, 124:297-305. 10.1378/chest.124.1.297, 12853537.
Rubinson L, Diette GB, Song X, Brower RG, Krishnan JA. Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit. Crit Care Med 2004, 32:350-357. 10.1097/01.CCM.0000089641.06306.68, 14758147.
Lin J, Lee DS, Chase JG, Hann CE, Lotz T, Wong XW. Stochastic modelling of insulin sensitivity variability in critical care. Biomedical Signal Processing & Control 2006, 1:229-242.
Lin J, Lee D, Chase JG, Shaw GM, Le Compte A, Lotz T, Wong J, Lonergan T, Hann CE. Stochastic modelling of insulin sensitivity and adaptive glycemic control for critical care. Comput Methods Programs Biomed 2008, 89:141-152. 10.1016/j.cmpb.2007.04.006, 17544541.
Preiser JC. Year in review 2008: Critical Care--metabolism. Crit Care 2009, 13:228. 10.1186/cc8024, 19863767.
Moreno R, Vincent JL, Matos R, Mendonca A, Cantraine F, Thijs L, Takala J, Sprung C, Antonelli M, Bruining H, Willatts S. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related Problems of the ESICM. Intensive Care Med 1999, 25:686-696. 10.1007/s001340050931, 10470572.
Hellawell DJ, Signorini DF, Pentland B. Simple assessment of outcome after acute brain injury using the Glasgow Outcome Scale. Scand J Rehabil Med 2000, 32:25-27. 10.1080/003655000750045703, 10782938.
Kerby JD, MacLennan PA, Burton JN, McGwin G, Rue LW. Agreement between prehospital and emergency department glasgow coma scores. J Trauma 2007, 63:1026-1031. 10.1097/TA.0b013e318157d9e8, 17993947.
Udekwu P, Kromhout-Schiro S, Vaslef S, Baker C, Oller D. Glasgow Coma Scale score, mortality, and functional outcome in head-injured patients. J Trauma 2004, 56:1084-1089. 10.1097/01.TA.0000124283.02605.A5, 15179250.
Tallgren M, Backlund M, Hynninen M. Accuracy of Sequential Organ Failure Assessment (SOFA) scoring in clinical practice. Acta Anaesthesiol Scand 2009, 53:39-45. 10.1111/j.1399-6576.2008.01825.x, 19032556.
Arts DG, de Keizer NF, Vroom MB, de Jonge E. Reliability and accuracy of Sequential Organ Failure Assessment (SOFA) scoring. Crit Care Med 2005, 33:1988-1993. 10.1097/01.CCM.0000178178.02574.AB, 16148470.
Zygun D, Berthiaume L, Laupland K, Kortbeek J, Doig C. SOFA is superior to MOD score for the determination of non-neurologic organ dysfunction in patients with severe traumatic brain injury: a cohort study. Crit Care 2006, 10:R115. 10.1186/cc5007, 1750966, 16882348.
Nfor TK, Walsh TS, Prescott RJ. The impact of organ failures and their relationship with outcome in intensive care: analysis of a prospective multicentre database of adult admissions. Anaesthesia 2006, 61:731-738. 10.1111/j.1365-2044.2006.04707.x, 16867083.
Papaioannou VE, Maglaveras N, Houvarda I, Antoniadou E, Vretzakis G. Investigation of altered heart rate variability, nonlinear properties of heart rate signals, and organ dysfunction longitudinally over time in intensive care unit patients. J Crit Care 2006, 21:95-103. discussion 103-104, 10.1016/j.jcrc.2005.12.007, 16616632.
Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001, 286:1754-1758. 10.1001/jama.286.14.1754, 11594901.
Felton TW, Sander R, Al-Aloul M, Dark P, Bentley AM. Can a score derived from the Critical Care Minimum Data Set be used as a marker of organ dysfunction? - a pilot study. BMC Res Notes 2009, 2:77. 10.1186/1756-0500-2-77, 2688517, 19419551.
Natali A, Gastaldelli A, Camastra S, Sironi AM, Toschi E, Masoni A, Ferrannini E, Mari A. Dose-response characteristics of insulin action on glucose metabolism: a non-steady-state approach. Am J Physiol Endocrinol Metab 2000, 278:E794-801.
Prigeon RL, Roder ME, Porte D, Kahn SE. The effect of insulin dose on the measurement of insulin sensitivity by the minimal model technique. Evidence for saturable insulin transport in humans. J Clin Invest 1996, 97:501-507. 10.1172/JCI118441, 507043, 8567973.
Chase JG, Shaw GM, Lin J, Doran CV, Bloomfield M, Wake GC, Broughton B, Hann C, Lotz T. Impact of insulin-stimulated glucose removal saturation on dynamic modelling and control of hyperglycaemia. International Journal of Intelligent Systems Technologies and Applications (IJISTA) 2004, 1:79-94.
Shaw GM, Chase JG, Wong J, Lin J, Lotz T, Le Compte AJ, Lonergan TR, Willacy MB, Hann CE. Rethinking glycaemic control in critical illness - from concept to clinical practice change. Crit Care Resusc 2006, 8:90-99.
Braithwaite SS, Edkins R, Macgregor KL, Sredzienski ES, Houston M, Zarzaur B, Rich PB, Benedetto B, Rutherford EJ. Performance of a dose-defining insulin infusion protocol among trauma service intensive care unit admissions. Diabetes Technol Ther 2006, 8:476-488. 10.1089/dia.2006.8.476, 16939372.
Goldberg PA, Siegel MD, Sherwin RS, Halickman JI, Lee M, Bailey VA, Lee SL, Dziura JD, Inzucchi SE. Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit. Diabetes Care 2004, 27:461-467. 10.2337/diacare.27.2.461, 14747229.
Mesotten D, Van den Berghe G. Clinical benefits of tight glycaemic control: focus on the intensive care unit. Best Pract Res Clin Anaesthesiol 2009, 23:421-429. 10.1016/j.bpa.2009.08.006, 20108581.
Griesdale DE, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, Dhaliwal R, Henderson WR, Chittock DR, Finfer S, Talmor D. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. Cmaj 2009, 180:821-827. 2665940, 19318387.