title: Hyperglycemia after SAH: predictors, associated complications, and impact on outcome.
abstract: 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.
authors.affiliation: Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Frontera
authors.forename: Andres
authors.initials: A
authors.lastname: Fernandez
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.forename: Michael
authors.initials: M
authors.lastname: Schmidt
authors.forename: H Christian
authors.initials: HC
authors.lastname: Schumacher
authors.forename: Katja
authors.initials: K
authors.lastname: Wartenberg
authors.forename: Richard
authors.initials: R
authors.lastname: Temes
authors.forename: Augusto
authors.initials: A
authors.lastname: Parra
authors.forename: Noeleen D
authors.initials: ND
authors.lastname: Ostapkovich
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
mesh_terms: 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
chemical_list: D001786:Blood Glucose; D005947:Glucose