Stress induced hyperglycemia after spontaneous subarachnoid hemorrhage and its role in predicting cerebrospinal fluid diversion.

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Stress induced hyperglycemia after spontaneous subarachnoid hemorrhage and its role in predicting cerebrospinal fluid diversion.

World Neurosurg. 2017 Jan 12;:

Authors: Ray B, Ludwig A, Yearout LK, Thompson DM, Bohnstedt BN

Abstract
BACKGROUND: Stress induced hyperglycemia (SIH) after acute cerebrovascular disease is common and is associated with adverse clinical outcomes. Incidence of SIH after spontaneous subarachnoid hemorrhage (SAH) and its role in shunt placement has not been systematically investigated. Present study is designed to investigate the incidence of SIH after spontaneous SAH and its determinants. 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 (AG): HbA1c ratio. Receiver Operating Characteristic (ROC) 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 using thresholds of 26.7 mg/dl for GG and 26 for AG: HbA1c ratio. The incidence of SIH was higher in patients with aneurysmal SAH (aSAH) [99/200 (49.5%)] than in those with non-aneurysmal SAH (naSAH) [16/50 (32.0%), p=0.03]. Among 200 aSAH patients, diabetics suffered higher mortality than non-diabetics [10/24 (41.7%) vs. 39/137 (21.2%), p=0.045]. SIH among non-hydrocephalic aSAH were more likely to have EVD placed than those without [42/64 (65.6%) vs. 38/79 (48.1%), p=0.043]. Among 143 aSAH patients without hydrocephalus EVD was placed more often in those with HbA1c≥6.4% [15/19 (78.9%) vs. 65/124 (52.4%), p=0.045]. Neither SIH nor HbA1c could predict VPS placement among aSAH survivors.
CONCLUSION: SIH is common after aSAH. In non-hydrocephalic aSAH, both SIH and premorbid uncontrolled hyperglycemia determines EVD but not VPS placement.

PMID: 28089808 [PubMed - as supplied by publisher]

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