title: Strict glucose control does not affect mortality after aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  The effects of both hyperglycemia and hypoglycemia are deleterious to patients with neurologic injury.
  
  
  METHODS
  On January 1, 2002, the neurointensive care unit at the University of Virginia Health System initiated a strict glucose control protocol (goal glucose < 120 mg/dl). The authors conducted an impact study to determine the effects of this protocol on patients presenting with aneurysmal subarachnoid hemorrhage.
  
  
  RESULTS
  Among the 834 patients admitted between 1995 and 2007, the in-hospital mortality was 11.6%. The median admission glucose for survivors was lower (135 vs. 176 mg/dl); however, on multivariate analysis, increasing admission glucose was not associated with a statistically significant increase in the risk of death (P = 0.064). The median average glucose for survivors was also lower (116 vs. 135 mg/dl). This was significant on multivariate analysis (P < 0.001); however, the effect was small (odds ratio, 1.045). Implementation of the strict glucose protocol decreased median average glucose (121 vs. 116 mg/dl, P < 0.001) and decreased the incidence of hyperglycemia. Implementation of the protocol had no effect on in-hospital mortality (11.7% vs. 12.0%, P = 0.876 [univariate], P = 0.132 [multivariate]). Protocol implementation was associated with an increased incidence of hypoglycemia (P < 0.001). Hypoglycemia was associated with a substantially increased risk of death on multivariate analysis (P = 0.009; odds ratio = 3.818).
  
  
  CONCLUSIONS
  The initiation of a tight glucose control regimen lowered average glucose levels but had no effect on overall in-hospital mortality.
authors.affiliation: Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Thiele
authors.forename: Nader
authors.initials: N
authors.lastname: Pouratian
authors.forename: Zhiyi
authors.initials: Z
authors.lastname: Zuo
authors.forename: David C
authors.initials: DC
authors.lastname: Scalzo
authors.forename: Heather A
authors.initials: HA
authors.lastname: Dobbs
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.forename: Neal F
authors.initials: NF
authors.lastname: Kassell
authors.forename: Edward C
authors.initials: EC
authors.lastname: Nemergut
mesh_terms: D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000517:prevention & control; D007003:Hypoglycemia / Q000097:blood / Q000517:prevention & control; D008297:Male; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000401:mortality*
chemical_list: D001786:Blood Glucose