TY - JOUR
T1 - Hyperglycemia after SAH
T2 - Predictors, associated complications, and impact on outcome
AU - Frontera, Jennifer A.
AU - Fernandez, Andres
AU - Claassen, Jan
AU - Schmidt, Michael
AU - Schumacher, H. Christian
AU - Wartenberg, Katja
AU - Temes, Richard
AU - Parra, Augusto
AU - Ostapkovich, Noeleen D.
AU - Mayer, Stephan A.
PY - 2006/1
Y1 - 2006/1
N2 - 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.
AB - 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.
KW - Hyperglycemia
KW - Outcome
KW - Subarachnoid hemorrhage
UR - http://www.scopus.com/inward/record.url?scp=33644875625&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33644875625&partnerID=8YFLogxK
U2 - 10.1161/01.STR.0000194960.73883.0f
DO - 10.1161/01.STR.0000194960.73883.0f
M3 - Article
C2 - 16339481
AN - SCOPUS:33644875625
VL - 37
SP - 199
EP - 203
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 1
ER -