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Organ failure and tight glycemic control in the SPRINT study.
Crit Care. 2010 Aug 12;14(4):R154
Authors: Chase JG, Pretty CG, Pfeifer L, Shaw GM, Preiser JC, Le Compte AJ, Lin J, Hewett D, Moorhead KT, Desaive T
ABSTRACT: 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 (3356 days) on SPRINT (August 2005 - April 2007) and 413 retrospective patients (3211 days) from 2 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[less than or equal to]5 each day and its trends over time and cohort/group. Organ-failure free days (all SOFA components [less than or equal to] 2) and number of organ failures (SOFA components > 2) are also compared. Cumulative time in 4.0-7.0 mmol/L band (cTIB) was evaluated daily to link tightness and consistency of TGC (cTIB[greater than or equal to]0.5) to SOFA[less than or equal to]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: 1 day; IQR: [1, 3] 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[less than or equal to]5 is different over the first 14 days (p=0.016), rising to ~75% for Pre-SPRINT and ~85% for SPRINT, with clear separation after 2 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[greater than or equal to]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[greater than or equal to]0.5) increased the likelihood SOFA[less than or equal to]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[greater than or equal to]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.
PMID: 20704712 [PubMed - as supplied by publisher]