Published Online
on December 8, 2005

A more recent version of this article appeared on January 1, 2006

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Submitted on July 15, 2005
Accepted on July 27, 2005

Hyperglycemia After SAH. Predictors, Associated Complications, and Impact on Outcome

Jennifer A. Frontera MD; Andres Fernandez MD; Jan Claassen MD; Michael Schmidt PhD; H. Christian Schumacher MD; Katja Wartenberg MD; Richard Temes MD; Augusto Parra MD; Noeleen D. Ostapkovich MS; and Stephan A. Mayer MD^*

From the Departments of Neurology (J.A.F., A.F., J.C., M.S., C.S., K.W., R.T., A.P., N.D.O., S.A.M.) and Neurosurgery (A.P., S.A.M.), Neurological Intensive Care Unit, Columbia University College of Physicians and Surgeons, New York, NY.

^* To whom correspondence should be addressed. E-mail: Sam14{at}columbia.edu.

Background and Purpose--Hyperglycemia is common after subarachnoid hemorrhage (SAH). The extent to which prolonged hyperglycemia contributes to in-hospital complications and poor outcome after SAH is unknown.

Methods--We studied an inception cohort of 281 SAH patients with an initial serum glucose level obtained within 3 days of SAH onset and who had at least 7 daily glucose measurements between SAH days 0 and 10. We defined mean glucose burden (GB) as the average peak daily glucose level >5.8 mmol/L (105 mg/dL). Hospital complications were recorded prospectively, and 3-month outcome was assessed with the modified Rankin scale.

Results--The median GB was 1.8 mmol/L (33 mg/dL). Predictors of high-GB included age 54 years, Hunt and Hess grade III-V, poor Acute Physiology and Chronic Health Evaluation (APACHE)-2 physiological subscores, and a history of diabetes mellitus (all P0.001). In a multivariate analysis, GB was associated with increased intensive care unit length of stay (P=0.003) and the following complications: congestive heart failure, respiratory failure, pneumonia, and brain stem compression from herniation (all P<0.05). After adjusting for Hunt-Hess grade, aneurysm size, and age, GB was an independent predictor of death (odds ratio, 1.10 per mmol/L; 95% CI, 1.01 to 1.21; P=0.027) and death or severe disability (modified Rankin scale score of 4 to 6; odds ratio, 1.17 per mmol/L; 95% CI 1.07 to 1.28, P<0.001).

Conclusions--Hyperglycemia after SAH is associated with serious hospital complications, increased intensive care unit length of stay, and an increased risk of death or severe disability.

Key words: hyperglycemia • outcome • subarachnoid hemorrhage

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Does Hyperglycemia Contribute to Secondary Injury in Subarachnoid Hemorrhage?

Jose I. Suarez
Stroke 2006 37: 8-19. [Full Text] [PDF]

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