The effect of diabetes on mortality in critically ill patients: a systematic review and meta-analysis.
Crit Care. 2011 Sep 13;15(5):R205
Authors: Siegelaar SE, Hickmann M, Hoekstra JB, Holleman F, Devries JH
Abstract
ABSTRACT: INTRODUCTION: Critically ill patients with diabetes are at increased risk for development of complications, but the impact of diabetes on mortality is unclear. We conducted a systematic review and meta-analysis to determine the effect of diabetes on mortality in critically ill patients, making a distinction between different intensive care unit (ICU) types. METHODS: We performed an electronic search of MEDLINE and EMBASE for studies that reported on mortality of adult ICU patients from May 2005 to May 2010. Two reviewers independently screened the 3220 publications obtained for information regarding ICU, hospital or 30-day mortality of patients with and without diabetes. The number of deaths among patients with and without diabetes and/or mortality risk associated with diabetes was extracted. When only crude survival data were provided, odds ratios (OR) and standard errors (SE) were calculated. Data were synthesized using inverse variance with OR's as the effect measure. A random effects model was used because of anticipated heterogeneity. RESULTS: We included 141 studies containing 12,489,574 patients, including 2,705,624 deaths (21.7%). Of these patients at least 2,327,178 (18.6%) had diabetes. Overall no association between the presence of diabetes and mortality risk was found. Analysis for ICU type showed a significant disadvantage for patients with diabetes for all mortality definitions when admitted at the surgical ICU (ICU mortality: OR [CI] 1.48 [1.04-2.11]; hospital mortality: 1.59 [1.28-1.97]; 30-day mortality: 1.62 [1.13-2.34]). In medical and mixed ICU's no effect of diabetes was seen for all outcomes. Sensitivity analysis showed that the disadvantage in the diabetic surgical population was attributable to cardiac surgery (1.77 [1.45-2.16], P<0.00001) and not to general surgery patients (1.21 [0.96-1.53], P=0.11). CONCLUSIONS: This meta-analysis showed that diabetes was not associated with increased mortality risk in any ICU population except for those who underwent cardiac surgery.
PMID: 21914173 [PubMed - as supplied by publisher]