Hyperglycemia after SAH: predictors, associated complications, and impact on outcome.
OBJECTIVE
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 > or =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< or =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.
Frontera
Jennifer A
JA
Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Fernandez
Andres
A
Claassen
Jan
J
Schmidt
Michael
M
Schumacher
H Christian
HC
Wartenberg
Katja
K
Temes
Richard
R
Parra
Augusto
A
Ostapkovich
Noeleen D
ND
Mayer
Stephan A
SA
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000473:pathology; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005947:Glucose / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome
D001786:Blood Glucose; D005947:Glucose