Hyperglycemia after SAH: Predictors, associated complications, and impact on outcome

Jennifer A. Frontera, Andres Fernandez, Jan Claassen, Michael Schmidt, H. Christian Schumacher, Katja Wartenberg, Richard Temes, Augusto Parra, Noeleen D. Ostapkovich, Stephan A. Mayer

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136 Scopus citations

Abstract

Background and Purpose - Hyperglycemia is common after subarachnoid hemorrhage (SAH). The extent to which prolonged hyperglycemia contributes to in-hospital complications and poor outcome after SAH is unknown. Methods - We studied an inception cohort of 281 SAH patients with an initial serum glucose level obtained within 3 days of SAH onset and who had at least 7 daily glucose measurements between SAH days 0 and 10. We defined mean glucose burden (GB) as the average peak daily glucose level >5.8 mmol/L (105 mg/dL). Hospital complications were recorded prospectively, and 3-month outcome was assessed with the modified Rankin scale. Results - The median GB was 1.8 mmol/L (33 mg/dL). Predictors of high-GB included age ≥54 years, Hunt and Hess grade III-V, poor Acute Physiology and Chronic Health Evaluation (APACHE)-2 physiological subscores, and a history of diabetes mellitus (all P≤0.001). In a multivariate analysis, GB was associated with increased intensive care unit length of stay (P=0.003) and the following complications: congestive heart failure, respiratory failure, pneumonia, and brain stem compression from herniation (all P<0.05). After adjusting for Hunt-Hess grade, aneurysm size, and age, GB was an independent predictor of death (odds ratio, 1.10 per mmol/L; 95% CI, 1.01 to 1.21; P=0.027) and death or severe disability (modified Rankin scale score of 4 to 6; odds ratio, 1.17 per mmol/L; 95% CI 1.07 to 1.28, P<0.001). Conclusions - Hyperglycemia after SAH is associated with serious hospital complications, increased intensive care unit length of stay, and an increased risk of death or severe disability.

Original languageEnglish (US)
Pages (from-to)199-203
Number of pages5
JournalStroke
Volume37
Issue number1
DOIs
StatePublished - Jan 1 2006

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Keywords

  • Hyperglycemia
  • Outcome
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Frontera, J. A., Fernandez, A., Claassen, J., Schmidt, M., Schumacher, H. C., Wartenberg, K., Temes, R., Parra, A., Ostapkovich, N. D., & Mayer, S. A. (2006). Hyperglycemia after SAH: Predictors, associated complications, and impact on outcome. Stroke, 37(1), 199-203. https://doi.org/10.1161/01.STR.0000194960.73883.0f