title: Moderate Hypoglycemia is associated with vasospasm, cerebral infarction, and 3-month disability after subarachnoid hemorrhage.
abstract: BACKGROUND
  Many ICUs have implemented protocols for tight glucose control, but there are few data on hypoglycemia and neurologic outcomes in patients with subarachnoid hemorrhage (SAH).
  
  
  METHODS
  We prospectively ascertained 172 patients with SAH, who were treated according to a standard protocol for target glucose 80-110 mg/dl. Outcomes were assessed with the modified Rankin scale (mRS) at 14 days, 28 days, and 3 months.
  
  
  RESULTS
  Worse neurologic injury at admission (P < 0.001) and a history of diabetes (P = 0.002) were associated with increased glucose variance. There was lower nadir glucose in patients with radiographic cerebral infarction (81 +/- 15 vs. 87 +/- 16 mg/dl, P = 0.02), symptomatic vasospasm (78 +/- 12 vs. 84 +/- 16 mg/dl, P = 0.04) and angiographic vasospasm (79 +/- 14 vs. 86 +/- 16 mg/dl, P = 0.01), but maximum and mean glucose values were not different. Glucose < 80 mg/dl was earlier and more frequent in patients with worse functional outcome at 3 months (P < 0.001). Progressive reductions in nadir glucose were associated with increasing functional disability at 3 months (P = 0.001) after accounting for neurologic grade and mean glucose. Severe hypoglycemia (<40 mg/dl) occurred in one patient.
  
  
  CONCLUSIONS
  In patients with SAH, nadir glucose < 80 mg/dl is associated with cerebral infarction, vasospasm, and worse functional outcomes in multivariate models. Protocols for target glucose 80-110 mg/dl effectively control hyperglycemia, but may place patients with SAH at risk for vasospasm, cerebral infarction, and poor outcome even when severe hypoglycemia does not occur.
authors.affiliation: Department of Neurology, School of Medicine, Northwestern University, 710 N Lake Shore Drive, 11th floor, Chicago, IL 60611, USA. a-naidech@northwestern.edu
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Naidech
authors.forename: Kimberly
authors.initials: K
authors.lastname: Levasseur
authors.forename: Storm
authors.initials: S
authors.lastname: Liebling
authors.forename: Rajeev K
authors.initials: RK
authors.lastname: Garg
authors.forename: Michael
authors.initials: M
authors.lastname: Shapiro
authors.forename: Michael L
authors.initials: ML
authors.lastname: Ault
authors.forename: Sherif
authors.initials: S
authors.lastname: Afifi
authors.forename: H Hunt
authors.initials: HH
authors.lastname: Batjer
mesh_terms: D002544:Cerebral Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology / Q000534:rehabilitation; D004185:Disability Evaluation; D005260:Female; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000453:epidemiology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology