A Meta-Analysis of Tight Versus Conventional Glycemic Control in Critically Ill Brain Injured Adults

To evaluate the benefits and risks of tight glycemia control (TGC) versus conventional glucose control (CGC) in critically ill brain injured adults. We performed meta-analysis by systematically searching PubMed, EMBASE, OVID, ScienceDirect, Web of Science, CNKI, Wanfang Data, and CQVIP databases to retrieve RCTs in any languages. We used Review Manager to perform meta-analysis. Odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated in analyses. Twenty six RCTs with a total of 3,759 participants were included in this meta-analysis. In-hospital mortality showed significant dissimilarity between TGC and CGC groups with OR of 0.76 (95% CI 0.58, 0.99). However, in terms of overall mortality and long term neurological severity outcome, it didn't show differences with ORs of 0.93 (95% CI 0.79, 1.10) and 1.15 (95% CI 0.96, 1.37). There were also discrepancies in infection rate and ICU length of stay (LOS) with OR of 0.51 (95% CI 0.42, 0.62) and WMD of −2.37 (95% CI −2.99, −1.74). Significances were observed in hypoglycemia events with ORs of 6.24 (95% CI 4.83, 8.07) and 2.73 (95% CI 2.56, 2.91) using two methods. In critically ill brain injury, TGC did not show beneficial effects on reducing overall mortality and long term neurological outcome, but it increased the risk of hypoglycemia.