title: Stress-Induced Hyperglycemia After Spontaneous Subarachnoid Hemorrhage and Its Role in Predicting Cerebrospinal Fluid Diversion.
abstract: BACKGROUND
  Stress-induced hyperglycemia (SIH) after acute cerebrovascular disease is common and is associated with adverse clinical outcomes. The incidence of SIH after spontaneous subarachnoid hemorrhage (SAH) and its role in shunt placement have not been systematically investigated. The present study is designed to investigate the incidence of SIH after spontaneous SAH and its determinants. The role of SIH and premorbid hyperglycemia (using glycated hemoglobin [HbA1c]) in predicting external ventricular drainage (EVD) and ventriculoperitoneal shunt (VPS) placement is also investigated.
  
  
  METHODS
  This study defined SIH using the glycemic gap (GG) and admission glucose:HbA1cratio. The receiver operating characteristic curve determined threshold values for GG and the ratio that best predicted incidence of adverse clinical outcomes, including in-hospital mortality.
  
  
  RESULTS
  We defined SIH using thresholds of 26.7 mg/dL for GG and 26 mg/dL for admission glucose:HbA1cratio. The incidence of SIH was higher in patients with aneurysmal SAH (aSAH) (99/200 [49.5%]) than in those with nonaneurysmal SAH (16/50 [32.0%]; P = 0.03). Among 200 patients with aSAH, diabetics had higher mortality than nondiabetics (10/24 [41.7%] vs. 39/137 [21.2%]; P = 0.045). SIH among nonhydrocephalic aSAH was more likely to have EVD placed than those without (42/64 [65.6%] vs. 38/79 [48.1%]; P = 0.043). Among 143 patients with aSAH without hydrocephalus, EVD was placed more often in those with HbA1clevel ≥6.4% (15/19 [78.9%] vs. 65/124 [52.4%]; P = 0.045). Neither SIH nor HbA1clevel could predict VPS placement among aSAH survivors.
  
  
  CONCLUSIONS
  SIH is common after aSAH. In nonhydrocephalic aSAH, both SIH and premorbid uncontrolled hyperglycemia determine EVD but not VPS placement.
authors.affiliation: Department of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. Electronic address: Bappaditya-Ray@ouhsc.edu.
authors.forename: Bappaditya
authors.initials: B
authors.lastname: Ray
authors.affiliation: Department of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Ludwig
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
authors.forename: Lori K
authors.initials: LK
authors.lastname: Yearout
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Thompson
authors.affiliation: Department of Neurosurgery, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Bohnstedt
mesh_terms: D015984:Causality; D002557:Cerebrospinal Fluid Shunts / Q000401:mortality* / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000401:mortality* / Q000628:therapy*; D006943:Hyperglycemia / Q000401:mortality*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009825:Oklahoma / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment; D013315:Stress, Psychological / Q000401:mortality*; D013345:Subarachnoid Hemorrhage; D015996:Survival Rate
keywords: Hemorrhagic stroke; Hydrocephalus; Hyperglycemia; Shunt