title: High glucose variability increases cerebral infarction in patients with spontaneous subarachnoid hemorrhage.
abstract: OBJECTIVE
  High glucose variability is a significant marker for poor outcome in critically ill patients. We evaluated the impact of high glucose variability on cerebral infarction following spontaneous subarachnoid hemorrhage (SAH).
  
  
  METHODS
  Consecutive adult patients with spontaneous SAH and Hunt Hess score of at least 3 were retrospectively identified. Patients were excluded if their intensive care unit length of stay was less than 24 hours or if there were less than 5 glucose assessments. Glucose values from the first 7 days of intensive care unit admission were assessed. Variability was calculated as the average change in glucose over time for each patient. Classification and regression tree analysis was used to determine high vs low glucose variability, and the incidence of cerebral infarction was compared. Multivariate analysis was used to control for confounding variables.
  
  
  RESULTS
  There were 42 patients. Classification and regression tree analysis revealed a change in glucose greater than 9.52 mg/dL/h as the determinant for high variability. The incidence of cerebral infarction was 64% when glucose variability was high vs 20% when it was low (P=.006). Multivariate analysis identified high glucose variability (odds ratio [95% confidence interval]=11.4 [1.9-70.2], P=.008) and female sex (odds ratio [95% confidence interval]=5.2 [1-26.8], P=.047) as independent predictors for cerebral infarction.
  
  
  CONCLUSIONS
  Glucose variability is a significant predictor of cerebral infarction in patients with severe spontaneous SAH.
authors: Department of Pharmacy Practice, Midwestern University, College of Pharmacy-Glendale, Glendale, AZ 85308, USA. Electronic address: jbarle@midwestern.edu.
authors: Jeffrey F
authors: JF
authors: Barletta
authors: Bryan E
authors: BE
authors: Figueroa
authors: Rob
authors: R
authors: DeShane
authors: Steven A
authors: SA
authors: Blau
authors: Karen J
authors: KJ
authors: McAllen
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism*; D002544:Cerebral Infarction / Q000097:blood* / Q000209:etiology*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000150:complications*
chemical_list: D015415:Biomarkers; D001786:Blood Glucose
keywords: Glucose; Infarction; Subarachnoid hemorrhage; Variability