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Open Access 01-08-2010 | Research

Organ failure and tight glycemic control in the SPRINT study

Authors: J Geoffrey Chase, Christopher G Pretty, Leesa Pfeifer, Geoffrey M Shaw, Jean-Charles Preiser, Aaron J Le Compte, Jessica Lin, Darren Hewett, Katherine T Moorhead, Thomas Desaive

Published in: Critical Care | Issue 4/2010

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 (3,356 days) on SPRINT (August 2005 - April 2007) and 413 retrospective patients (3,211 days) from two 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 ≤5 each day and its trends over time and cohort/group. Organ-failure free days (all SOFA components ≤2) and number of organ failures (SOFA components >2) are also compared. Cumulative time in 4.0 to 7.0 mmol/L band (cTIB) was evaluated daily to link tightness and consistency of TGC (cTIB ≥0.5) to SOFA ≤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: one 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 ≤5 is different over the first 14 days (P = 0.016), rising to approximately 75% for Pre-SPRINT and approximately 85% for SPRINT, with clear separation after two 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 ≥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 ≥0.5) increased the likelihood SOFA ≤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 ≥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.

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Title: Organ failure and tight glycemic control in the SPRINT study
Authors: J Geoffrey Chase
Christopher G Pretty
Leesa Pfeifer
Geoffrey M Shaw
Jean-Charles Preiser
Aaron J Le Compte
Jessica Lin
Darren Hewett
Katherine T Moorhead
Thomas Desaive
Publication date: 01-08-2010
Publisher: BioMed Central
Published in: Critical Care / Issue 4/2010
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc9224

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Organ failure and tight glycemic control in the SPRINT study

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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