Sophie Penning1, J Geoffrey Chase2, Jean-Charles Preiser3, Christopher G Pretty4, Matthew Signal5, Christian Mélot6, Thomas Desaive7. 1. GIGA-Cardiovascular Sciences, Institut de Physique, Université de Liege, Institut de Physics, Allée du 6 Août, 17 (Bât B5), B4000 Liege, Liege, Belgium. Electronic address: Sophie.Penning@ulg.ac.be. 2. Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, Private Bag 4800, 8054, New Zealand. Electronic address: geoff.chase@canterbury.ac.nz. 3. Department of Intensive Care, Erasme University Hospital, 808 route de Lennik, B1070 Brussels, Belgium. Electronic address: Jean-Charles.Preiser@erasme.ulb.ac.be. 4. Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, Private Bag 4800, 8054, New Zealand. Electronic address: chris.pretty@canterbury.ac.nz. 5. Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, Private Bag 4800, 8054, New Zealand. Electronic address: matthew.signal@pg.canterbury.ac.nz. 6. Department of Emergency Medicine, Erasme University Hospital, Brussels, Belgium. Electronic address: cmelot@ulb.ac.be. 7. GIGA-Cardiovascular Sciences, Institut de Physique, Université de Liege, Institut de Physics, Allée du 6 Août, 17 (Bât B5), B4000 Liege, Liege, Belgium. Electronic address: tdesaive@ulg.ac.be.
Abstract
OBJECTIVE: This research evaluates the impact of the achievement of an intermediate target glycemic band on the severity of organ failure and mortality. METHODS:Daily Sequential Organ Failure Assessment (SOFA) score and the cumulative time in a 4.0 to 7.0 mmol/L band (cTIB) were evaluated daily up to 14 days in 704 participants of the multicentre Glucontrol trial (16 centers) that randomized patients to intensive group A (blood glucose [BG] target: 4.4-6.1 mmol/L) or conventional group B (BG target: 7.8-10.0 mmol/L). Sequential Organ Failure Assessment evolution was measured by percentage of patients with SOFA less than or equal to 5 on each day, percentage of individual organ failures, and percentage of organ failure-free days. Conditional and joint probability analysis of SOFA and cTIB 0.5 or more assessed the impact of achieving 4.0 to 7.0 mmol/L target glycemic range on organ failure. Odds ratios (OR) compare the odds risk of death for cTIB 0.5 or more vs cTIB less than 0.5, where a ratio greater than 1.0 indicates an improvement for achieving cTIB 0.5 or more independent of SOFA or glycemic target. RESULTS: Groups A and B were matched for demographic and severity of illness data. Blood glucose differed between groups A and B (P<.05), as expected. There was no difference in the percentage of patients with SOFA less than or equal to 5, individual organ failures, and organ failure-free days between groups A and B over days 1 to 14. However, 20% to 30% of group A patients failed to achieve cTIB 0.5 or more for all days, and significant crossover confounds interpretation. Mortality OR was greater than 1.0 for patients with cTIB 0.5 or more in both groups but much higher for group A on all days. CONCLUSIONS: There was no difference in organ failure in the Glucontrol study based on intention to treat to different glycemic targets. Actual outcomes and significant crossover indicate that this result may not be due to the difference in target or treatment. Odds ratios-associated achieving an intermediate 4.0 to 7.0 mmol/L range improved outcome.
RCT Entities:
OBJECTIVE: This research evaluates the impact of the achievement of an intermediate target glycemic band on the severity of organ failure and mortality. METHODS: Daily Sequential Organ Failure Assessment (SOFA) score and the cumulative time in a 4.0 to 7.0 mmol/L band (cTIB) were evaluated daily up to 14 days in 704 participants of the multicentre Glucontrol trial (16 centers) that randomized patients to intensive group A (blood glucose [BG] target: 4.4-6.1 mmol/L) or conventional group B (BG target: 7.8-10.0 mmol/L). Sequential Organ Failure Assessment evolution was measured by percentage of patients with SOFA less than or equal to 5 on each day, percentage of individual organ failures, and percentage of organ failure-free days. Conditional and joint probability analysis of SOFA and cTIB 0.5 or more assessed the impact of achieving 4.0 to 7.0 mmol/L target glycemic range on organ failure. Odds ratios (OR) compare the odds risk of death for cTIB 0.5 or more vs cTIB less than 0.5, where a ratio greater than 1.0 indicates an improvement for achieving cTIB 0.5 or more independent of SOFA or glycemic target. RESULTS: Groups A and B were matched for demographic and severity of illness data. Blood glucose differed between groups A and B (P<.05), as expected. There was no difference in the percentage of patients with SOFA less than or equal to 5, individual organ failures, and organ failure-free days between groups A and B over days 1 to 14. However, 20% to 30% of group A patients failed to achieve cTIB 0.5 or more for all days, and significant crossover confounds interpretation. Mortality OR was greater than 1.0 for patients with cTIB 0.5 or more in both groups but much higher for group A on all days. CONCLUSIONS: There was no difference in organ failure in the Glucontrol study based on intention to treat to different glycemic targets. Actual outcomes and significant crossover indicate that this result may not be due to the difference in target or treatment. Odds ratios-associated achieving an intermediate 4.0 to 7.0 mmol/L range improved outcome.
Authors: Athirah Abdul Razak; Asma Abu-Samah; Normy Norfiza Abdul Razak; Ummu Jamaludin; Fatanah Suhaimi; Azrina Ralib; Mohd Basri Mat Nor; Christopher Pretty; Jennifer Laura Knopp; James Geoffrey Chase Journal: Med Devices (Auckl) Date: 2020-06-04
Authors: Vincent Uyttendaele; Jennifer L Dickson; Geoffrey M Shaw; Thomas Desaive; J Geoffrey Chase Journal: Crit Care Date: 2017-06-24 Impact factor: 9.097
Authors: J Geoffrey Chase; Jean-Charles Preiser; Jennifer L Dickson; Antoine Pironet; Yeong Shiong Chiew; Christopher G Pretty; Geoffrey M Shaw; Balazs Benyo; Knut Moeller; Soroush Safaei; Merryn Tawhai; Peter Hunter; Thomas Desaive Journal: Biomed Eng Online Date: 2018-02-20 Impact factor: 2.819
Authors: Vincent Uyttendaele; Jennifer L Knopp; Shaun Davidson; Thomas Desaive; Balazs Benyo; Geoffrey M Shaw; J Geoffrey Chase Journal: Biomed Eng Online Date: 2019-10-22 Impact factor: 2.819
Authors: Vincent Uyttendaele; Jennifer L Knopp; Geoffrey M Shaw; Thomas Desaive; J Geoffrey Chase Journal: Biomed Eng Online Date: 2020-04-29 Impact factor: 2.819
Authors: Vincent Uyttendaele; J Geoffrey Chase; Jennifer L Knopp; Rebecca Gottlieb; Geoffrey M Shaw; Thomas Desaive Journal: Ann Intensive Care Date: 2021-01-21 Impact factor: 6.925