Higher mean inpatient blood glucose values increased the risk for symptomatic vasospasm after subarachnoid hemorrhage (RR 1.01; 95% CI 1.0-1.03; p=0.04).
Observational (n=352)
Does hyperglycemia increase the risk of symptomatic vasospasm and poor clinical outcomes in patients with aneurysmal subarachnoid hemorrhage?
Higher mean inpatient blood glucose levels are associated with an increased risk of symptomatic vasospasm and poorer clinical outcomes following aneurysmal subarachnoid hemorrhage.
Relative Risk: 1.01 (95% CI 1–1.03)
p-value: p=0.04
OBJECTIVE: To determine the relationship between blood glucose levels (mg/dL) and occurrence of symptomatic vasospasm (VSP) and clinical outcomes after aneurysmal subarachnoid hemorrhage. DESIGN: Retrospective observational study of 352 patients with subarachnoid hemorrhage admitted within 48 hrs of ictus between January 1995 and June 2002. SETTING: Neurointensive care unit. PATIENTS: Adult patients admitted after subarachnoid hemorrhage. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Variables included age; Hunt-Hess classification score; Fisher group; insulin use; infectious disease status; history of diabetes mellitus; and blood glucose values. Poor clinical outcome was defined by a modified Rankin score > or =3, and hyperglycemia was defined by a blood glucose level >140 mg/dL. Mean daily blood glucose values were assessed from admission to development of VSP or day 14. Mean admission blood glucose value, mean inpatient blood glucose value, insulin use, infectious disease status, Hunt-Hess classification score, Fisher group, and history of diabetes mellitus were entered in a Cox proportional hazards model. VSP occurred in 103 (29.2%) of 352 patients. Mean admission blood glucose values (176.6 +/- 40.3 mg/dL vs. 162.3 +/- 47.8 mg/dL; p = .01) and mean inpatient blood glucose values (166.2 +/- 24.7 mg/dL vs. 155.8 +/- 29.7 mg/dL; p = .001) were significantly higher in patients with VSP. Mean inpatient blood glucose value (relative risk, 1.01; 95% confidence interval, 1.0-1.03; p = .04), Hunt-Hess classification score > or =3 (relative risk, 2.23; 95% confidence interval, 1.21-3.99; p = .02), and Fisher group score of 3 (relative risk, 1.28; 95% confidence interval, 1.15-3.1; p = .05) increased the risk for VSP. Hyperglycemia was associated with longer length of stay in the neurointensive care unit (14.5 +/- 7.1 days vs. 11.6 +/- 5.4 days; p or =3: 58.9% vs. 18.8%; p < .001). CONCLUSIONS: Mean inpatient blood glucose value is associated with the development of VSP and may represent a target for therapy to prevent VSP and improve clinical outcomes.
Badjatia et al. (Fri,) conducted a observational in aneurysmal subarachnoid hemorrhage (n=352). Higher mean inpatient blood glucose vs. Lower mean inpatient blood glucose was evaluated on symptomatic vasospasm (VSP) (RR 1.01, 95% CI 1.0-1.03, p=0.04). Higher mean inpatient blood glucose values increased the risk for symptomatic vasospasm after subarachnoid hemorrhage (RR 1.01; 95% CI 1.0-1.03; p=0.04).