Abstract:
AIMS:To document the impact of intensive insulin therapy during intensive care on long-term (4 years) outcome of high-risk cardiac surgery patients. METHODS AND RESULTS:In this pre-planned sub-analysis and follow-up study of a large, randomized controlled trial on the effects of intensive insulin therapy during critical illness, we assessed long-term outcome in the 970 patients who had been admitted after high-risk cardiac surgery (mean+/-SD EuroSCORE of 6.0+/-3.7; EuroSCORE-predicted hospital mortality of 9.9%; observed hospital mortality of 7.5% in the conventional insulin group and 3.4% in the intensive insulin group). Long-term outcome was quantified as: (a) 4 years survival; (b) incidence of hospital re-admission; (c) level of activity and medical care requirements at 4 years as assessed by the Karnofsky score; and (d) perceived health-related quality-of-life at 4 years as assessed by the Nottingham Health Profile. Four years after ICU admission, the number of post-hospital discharge deaths was similar in the two study groups, reflecting maintenance of the acute survival benefit with intensive insulin therapy. Survivors who had been treated with intensive insulin during ICU stay revealed a similar risk for hospital re-admission and a comparable level of dependency on medical care. There was no effect on quality-of-life in the total group, whereas the increased survival of sicker patients with at least 3 days of insulin therapy evoked a more compromised perceived quality-of-life, in particular regarding social and family life. CONCLUSION:The short-term survival benefit obtained with insulin-titrated glycaemic control during intensive care after cardiac surgery was maintained after 4 years, without inducing increased medical care requirements but possibly at the expense of compromised perceived quality of social and family life.
journal_name
Eur Heart Jjournal_title
European heart journalauthors
Ingels C,Debaveye Y,Milants I,Buelens E,Peeraer A,Devriendt Y,Vanhoutte T,Van Damme A,Schetz M,Wouters PJ,Van den Berghe Gdoi
10.1093/eurheartj/ehi855subject
Has Abstractpub_date
2006-11-01 00:00:00pages
2716-24issue
22eissn
0195-668Xissn
1522-9645pii
ehi855journal_volume
27pub_type
杂志文章,随机对照试验abstract::Measurement of the pre-ejection period (PEP) can give valuable information on myocardial function in rats. Depressed cardiac function is accompanied by prolongation of PEP, which shortens when cardiac function improves. Left ventricular ejection time (LVET) may be shortened with ageing in spontaneously hypertensive ra...
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journal_title:European heart journal
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pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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pub_type: 临床试验,杂志文章,随机对照试验
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