title: Blood Glucose Variability: A Strong Independent Predictor of Neurological Outcomes in Aneurysmal Subarachnoid Hemorrhage.
abstract: OBJECTIVE
  In patients with aneurysmal subarachnoid hemorrhage (SAH), increased glucose variability (GV) is associated with increased mortality and cerebral infarction; however, there are no reports demonstrating an association between GV and neurological outcome. This study investigated whether GV had an independent effect on neurological outcomes in patients with SAH in the intensive care unit.
  
  
  METHODS
  Consecutive adult patients hospitalized with SAH between January 1, 2009, and May 31, 2015 (N = 122) were retrospectively reviewed. Univariate/multivariate analyses were performed to identify independent predictors of poor neurological outcome. Patients were divided according to the mean glucose level (80-139 vs 140-200 mg/dL) and further subdivided using quartiles (Q) of the standard deviation (SD, representing variability) of the glucose level (Q1, Q2 + 3, and Q4).
  
  
  RESULTS
  Unfavorable neurological outcomes occurred in 44.2% of the patients. On multiple regression analysis, age, Hunt and Kosnik grade, SD of glucose (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.02-1.17; P < .01), and minimum blood glucose level (OR, 0.95; 95% CI, 0.91-0.99; P < .01) were significantly associated with unfavorable neurological outcomes. Both groups (mean glucose levels: 80-139 and 140-200 mg/dL groups) had increasing unfavorable neurological outcomes with increasing SD of glucose (Q1, 15.0%; Q2 + 3, 40.0%; Q4, 52.4% and Q1, 44.4%; Q2 + 3, 50%; Q4, 88.9% in the 80-139 and 140-200 mg/dL groups, respectively). Patients with minimum glucose of <90 mg/dL comprised >50% of unfavorable neurological outcome.
  
  
  CONCLUSIONS
  Increased GV was an independent predictor of unfavorable neurological outcomes in patients with SAH.
authors.affiliation: 1 Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan.|Dr. Okazaki and Dr. Hifumi contributed equally to this work.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Okazaki
authors.affiliation: 1 Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan.|Dr. Okazaki and Dr. Hifumi contributed equally to this work.
authors.forename: Toru
authors.initials: T
authors.lastname: Hifumi
authors.affiliation: 1 Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Kawakita
authors.affiliation: 1 Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Shishido
authors.affiliation: 2 Department of Neurosurgery, Kagawa University Hospital, Kagawa, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ogawa
authors.affiliation: 2 Department of Neurosurgery, Kagawa University Hospital, Kagawa, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Okauchi
authors.affiliation: 2 Department of Neurosurgery, Kagawa University Hospital, Kagawa, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shindo
authors.affiliation: 2 Department of Neurosurgery, Kagawa University Hospital, Kagawa, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kawanishi
authors.affiliation: 2 Department of Neurosurgery, Kagawa University Hospital, Kagawa, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tamiya
authors.affiliation: 1 Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kuroda
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000097:blood* / Q000209:etiology; D016017:Odds Ratio; D012044:Regression Analysis; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000097:blood / Q000150:complications*
chemical_list: D001786:Blood Glucose
keywords: glucose variability; intensive care unit; outcome; subarachnoid hemorrhage