Effect of glucose�insulin�potassium infusion on mortality in critically ill patients: a systematic review and meta-analysis

Abstract

Introduction: Fifty years' worth of published evidence has inferred benefits of glucose-insulin-potassium (GIK) infusion to critically ill patients. We sought to measure the treatment effect of GIK infusion on mortality in critically ill patients. Methods: We conducted a systematic review of the Cochrane Library, MEDLINE, EMBASE, CINAHL, conference proceedings, clinical practice guidelines, and other sources using a comprehensive strategy. We identified randomized controlled trials comparing GIK treatment with standard care or placebo in critically ill adult patients. The primary outcome variable was mortality. Two authors independently extracted data and assessed study quality using standardized instruments; consensus was reached by conference. Preplanned subgroup analysis included studies of high-quality methodology, septic shock or other circulatory shock populations. We used the chi-square test and the proportion of total variation in study estimates that is due to heterogeneity (I2) to assess for statistical heterogeneity (P <0.10, I2 >25%). The primary analysis was based on the random effects model to produce pooled ORs with 95% CIs. Results: The search yielded 1,720 potential publications; 23 studies were included in the final analysis, providing a sample of 22,525 patients. Included studies only contained populations of acute myocardial infarction and cardiovascular surgery patients. The combined results demonstrate no statistically significant heterogeneity (P = 0.57, I2 = 0%) and no effect on mortality (OR = 1.02; 95% CI = 0.93 to 1.11) with GIK treatment. Among the highquality studies (n = 4) there was no effect on mortality (OR = 1.04; 95% CI = 0.95 to 1.14). No experimental studies of shock or sepsis populations were identified. Conclusions: This meta-analysis found that there is no mortality benefit to GIK infusion in critically ill patients; however, study populations were limited to acute myocardial infarction and cardiovascular surgery patients. No studies were identified utilizing GIK in patients with septic shock or other forms of circulatory shock, providing an absence of evidence regarding the effect of GIK as a therapy in patients with shock