title: Effects of tight computerized glucose control on neurological outcome in severely brain injured patients: a multicenter sub-group analysis of the randomized-controlled open-label CGAO-REA study.
abstract: BACKGROUND
  Hyperglycemia is a marker of poor prognosis in severe brain injuries. There is currently little data regarding the effects of intensive insulin therapy (IIT) on neurological recovery.
  
  
  METHODS
  A sub-group analysis of the randomized-controlled CGAO-REA study (NCT01002482) in surgical intensive care units (ICU) of two university hospitals. Patients with severe brain injury, with an expected ICU length of stay ≥ 48 hours were included. Patients were randomized between a conventional glucose management group (blood glucose target between 5.5 and 9 mmol.L(-1)) and an IIT group (blood glucose target between 4.4 and 6 mmol.L(-1)). The primary outcome was the day-90 neurological outcome evaluated with the Glasgow outcome scale.
  
  
  RESULTS
  A total of 188 patients were included in this analysis. In total 98 (52%) patients were randomized in the control group and 90 (48%) in the IIT group. The mean Glasgow coma score at baseline was 7 (± 4). Patients in the IIT group received more insulin (130 (68 to 251) IU versus 74 (13 to 165) IU in the control group, P = 0.01), had a significantly lower morning blood glucose level (5.9 (5.1 to 6.7) mmol.L(-1) versus 6.5 (5.6 to 7.2) mmol.L(-1), P <0.001) in the first 5 days after ICU admission. The IIT group experienced more episodes of hypoglycemia (P < 0.0001). In the IIT group 24 (26.6%) patients had a favorable neurological outcome (good recovery or moderate disability) compared to 31 (31.6%) in the control group (P = 0.4). There were no differences in day-28 mortality. The occurrence of hypoglycemia did not influence the outcome.
  
  
  CONCLUSIONS
  In this sub-group analysis of a large multicenter randomized trial, IIT did not appear to alter the day-90 neurological outcome or ICU morbidity in severe brain injured patients or ICU morbidity.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Cinotti
authors.forename: Carole
authors.initials: C
authors.lastname: Ichai
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Orban
authors.forename: Pierre
authors.initials: P
authors.lastname: Kalfon
authors.forename: Fanny
authors.initials: F
authors.lastname: Feuillet
authors.forename: Antoine
authors.initials: A
authors.lastname: Roquilly
authors.forename: Bruno
authors.initials: B
authors.lastname: Riou
authors.forename: Yvonnick
authors.initials: Y
authors.lastname: Blanloeil
authors.forename: Karim
authors.initials: K
authors.lastname: Asehnoune
authors.forename: Bertrand
authors.initials: B
authors.lastname: Rozec
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001930:Brain Injuries / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D000091402:Prohibitins; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; C000717331:PHB2 protein, human; D000091402:Prohibitins