BackgroundStress-related hyperglycaemia (SHG) is commonly seen in acutely ill patients and has been associated with poor outcomes in many studies performed in different acute care settings. We aimed to review the available evidence describing the associations between SHG and different outcomes in acutely ill patients admitted to an ICU. Study designs, populations, and outcome measures used in observational studies were analysed.MethodsWe conducted a systematic scoping review of observational studies following the Joanna Briggs methodology. Medline, Embase, and the Cochrane Library were searched for publications between January 2000 and December 2015 that reported on SHG and mortality, infection rate, length of stay, time on ventilation, blood transfusions, renal replacement therapy, or acquired weakness.ResultsThe search yielded 3,063 articles, of which 43 articles were included (totalling 536,476 patients). Overall, the identified studies were heterogeneous in study conduct, SHG definition, blood glucose measurements and monitoring, treatment protocol, and outcome reporting. The most frequently reported outcomes were mortality (38 studies), ICU and hospital length of stay (23 and 18 studies, respectively), and duration of mechanical ventilation (13 studies). The majority of these studies (40 studies) compared the reported outcomes in patients who experienced SHG with those who did not. Fourteen studies (35.9%) identified an association between hyperglycaemia and increased mortality (odds ratios ranging from 1.13 to 2.76). Five studies identified hyperglycaemia as an independent risk factor for increased infection rates, and one identified it as an independent predictor of increased ICU length of stay.DiscussionSHG was consistently associated with poor outcomes. However, the wide divergences in the literature mandate standardisation of measuring and monitoring SHG and the creation of a consensus on SHG definition. A better comparability between practices will improve our knowledge on SHG consequences and management.
of BR have been proposed to support this challenging process. Bayesian analysis, with its formal utilization of prior information and repeated updates based on accumulating knowledge, naturally supports decision theory. In this talk, we discuss the rationale for adopting a Bayesian framework when evaluating BR for decisionmaking purposes by providing an overview of recent applications of Bayesian statistics to structured quantitative BR assessment. Furthermore, we outline specific gaps and opportunities in the current practice of BR evaluation that support the case for greater application of statistical decision theory and Bayesian analysis.
ber of exacerbations during the 6 month follow-up following initial exacerbation. We also compared health care utilization between both groups. Results: Among 115,489 infants (mean age: 13.9 months; 62.9% boys), 4,477 infants of the MTL-4 group were matched with 13,386 infants of the ICS group. In multivariate analysis, the risk of a new exacerbation was lower in infants of MTL-4 group compared to infants in ICS group (HR= 0.91, IC95% [0.87; 0.95]). The total number of exacerbations did not differ between the 2 groups during the 6-month follow-up (p= 0,8617), neither the cost of asthma management (344€ for MTL-4 group vs. 308€ for ICS group, p= 0.1410). ConClusions: MTL-4 and ICS appear to be comparable therapeutic strategies, with similar effects on exacerbation and equivalent costs. The SNIIR-AM allows conducting comparative effectiveness research.
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