A systematic review and meta-analysis on glycemic control in traumatic brain injury

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2024-08-10 DOI:10.1016/j.clineuro.2024.108504

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引用次数: 0

Abstract

Background

Hyperglycemia is associated with adverse outcomes in patent with traumatic brain injury. There is convincing evidence of the deleterious effects of early systemic hyperglycemia on neurological outcomes and guides management toward intensive glycemic control. The purpose of this systematic review and meta analysis is to evaluate and summarize the level of evidence on the role of glycemic control in traumatic brain injury.

Methods

A systematic review and meta-analysis were performed following PRISMA guidelines. This review involved studies conducted in humans covering glycemic control in traumatic brain injury. A systematic literature search was performed in PubMed, Embase, EBSCO Host, Scopus, ScienceDirect, Medline, and LILACS from database inception to October 2020. The risk of bias was evaluated with the GRADE quality Scale.

Results

The results of this meta-analysis that involved 1236 patients included in 10 studies suggest that intensive glycemic control did not show significant differences in mortality compared with conservative management (RR 0.99 [95 % CI 0.81–1.21] p = 0.92). Intensive glycemic control reduced the risk of unfavorable clinical outcomes compared to standard management (RR 0.87 [95 % CI 0.78–0.96] p = 0.007) and increased favorable clinical outcomes compared to standard neurocritical care (RR 1.19 [95 % CI 1.02–138] p = 0.003).

Conclusions

The possible effect of glycemic control could be associated with silent hypoglycemic episodes during intensive care. Further studies evaluating the impact of glycemic control in traumatic brain injury are necessary.

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关于脑外伤患者血糖控制的系统回顾和荟萃分析

背景高血糖与脑外伤患者的不良预后有关。有令人信服的证据表明，早期全身性高血糖会对神经系统的预后产生有害影响，并指导患者加强血糖控制。本系统综述和荟萃分析的目的是评估和总结血糖控制在脑外伤中的作用的证据水平。方法按照 PRISMA 指南进行了系统综述和荟萃分析。本综述涉及脑外伤血糖控制方面的人体研究。在 PubMed、Embase、EBSCO Host、Scopus、ScienceDirect、Medline 和 LILACS 等数据库中进行了系统性文献检索，检索时间从数据库建立之初至 2020 年 10 月。结果这项荟萃分析涉及 10 项研究中的 1236 名患者，结果表明，与保守治疗相比，强化血糖控制在死亡率方面没有显著差异（RR 0.99 [95 % CI 0.81-1.21] p = 0.92）。与标准管理相比，强化血糖控制降低了不利临床结果的风险（RR 0.87 [95 % CI 0.78-0.96] p = 0.007），与标准神经重症监护相比，强化血糖控制增加了有利临床结果（RR 1.19 [95 % CI 1.02-138] p = 0.003）。有必要开展进一步研究，评估血糖控制对创伤性脑损伤的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.