on March 12, 2009
Published online before print March 12, 2009, doi: 10.1161/STROKEAHA.108.535534
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Submitted on August 25, 2008
From the Department of Neurology (J.G.S.L.), SUNY Upstate Medical University, Syracuse, NY; the Department of Neurology (S.H.-Y.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; the Departments of Neurology and Interventional Neuroradiology (R.G.N.), Neurosurgery (B.S.C., C.S.O.), and Neurology (A.B.S., G.A.R.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass. * To whom correspondence should be addressed. E-mail: latorrej{at}upstate.edu.
Background and Purpose—Hyperglycemia strongly predicts poor outcome in patients with aneurysmal subarachnoid hemorrhage, but the effect of hyperglycemia management on outcome is unclear. We studied the impact of glycemic control on outcome of patients with aneurysmal subarachnoid hemorrhage. Methods—A prospective intensive care unit database was used to identify 332 patients with hyperglycemic aneurysmal subarachnoid hemorrhage admitted between January 2000 and December 2006. Patients treated with an aggressive hyperglycemia management (AHM) protocol after 2003 (N=166) were compared with 166 patients treated using a standard hyperglycemia management before 2003. Within the AHM group, outcome was compared between patients who achieved good (mean glucose burden <1.1 mmol/L) and poor (mean glucose burden Results—Poor outcome in AHM-treated patients was lower (28.31% versus 40.36%) but was not statistically significant after correcting for temporal trend. However, good glycemic control significantly reduced the incidence of poor outcome (OR, 0.25; 95% CI, 0.08 to 0.80; P=0.02) compared with patients with poor glycemic control within the AHM group. No difference in the rate of clinical vasospasm or the development of delayed ischemic neurological deficit was seen before and after AHM protocol implementation. Conclusion—AHM results in good glucose control and significantly reduces the odds for poor outcome after aneurysmal subarachnoid hemorrhage in glucose-controlled patients. Further studies are needed to confirm these results.
Revised on October 4, 2008
Accepted on November 4, 2008
Effective Glycemic Control With Aggressive Hyperglycemia Management Is Associated With Improved Outcome in Aneurysmal Subarachnoid Hemorrhage
Julius Gene S. Latorre MD, MPH*;
1.1 mmol/L) glycemic control. Poor outcome was defined as modified Rankin scale 4 at 3 to 6 months. Multivariable logistic regression models correcting for temporal trend were used to quantify the effect of AHM on poor outcome.
Key words: critical care • hyperglycemia • intracranial aneurysm • outcome • subarachnoid hemorrhage