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 >or=1.1 mmol/L) glycemic control. Poor outcome was defined as modified Rankin scale >or=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. 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. CONCLUSIONS: 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.
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 >or=1.1 mmol/L) glycemic control. Poor outcome was defined as modified Rankin scale >or=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. 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. CONCLUSIONS: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.
Authors: M R Mayberg; H H Batjer; R Dacey; M Diringer; E C Haley; R C Heros; L L Sternau; J Torner; H P Adams; W Feinberg Journal: Stroke Date: 1994-11 Impact factor: 7.914
Authors: Paul M Vespa; David McArthur; Kristine O'Phelan; Thomas Glenn; Maria Etchepare; Daniel Kelly; Marvin Bergsneider; Neil A Martin; David A Hovda Journal: J Cereb Blood Flow Metab Date: 2003-07 Impact factor: 6.200
Authors: Greet Van den Berghe; Pieter J Wouters; Roger Bouillon; Frank Weekers; Charles Verwaest; Miet Schetz; Dirk Vlasselaers; Patrick Ferdinande; Peter Lauwers Journal: Crit Care Med Date: 2003-02 Impact factor: 7.598
Authors: Tracey A Baird; Mark W Parsons; Thanh Phan; Thanh Phanh; Ken S Butcher; Patricia M Desmond; Brian M Tress; Peter G Colman; Brian R Chambers; Stephen M Davis Journal: Stroke Date: 2003-07-31 Impact factor: 7.914
Authors: Nyika D Kruyt; Geert Jan Biessels; J Hans DeVries; Merel J A Luitse; Marinus Vermeulen; Gabriel J E Rinkel; W Peter Vandertop; Yvo B Roos Journal: J Cereb Blood Flow Metab Date: 2010-07-14 Impact factor: 6.200
Authors: Raimund Helbok; J Michael Schmidt; Pedro Kurtz; Khalid A Hanafy; Luis Fernandez; R Morgan Stuart; Mary Presciutti; Noeleen D Ostapkovich; E Sander Connolly; Kiwon Lee; Neeraj Badjatia; Stephan A Mayer; Jan Claassen Journal: Neurocrit Care Date: 2010-06 Impact factor: 3.210
Authors: Andrew M Naidech; Kimberly Levasseur; Storm Liebling; Rajeev K Garg; Michael Shapiro; Michael L Ault; Sherif Afifi; H Hunt Batjer Journal: Neurocrit Care Date: 2010-04 Impact factor: 3.210
Authors: N D Kruyt; G J Biessels; T M Vriesendorp; J H Devries; J B L Hoekstra; P W Elbers; L J Kappelle; P Portegies; M Vermeulen; Y B W E M Roos Journal: Neurocrit Care Date: 2009-05-27 Impact factor: 3.210
Authors: Shaurya Taran; Vatsal Trivedi; Jeffrey M Singh; Shane W English; Victoria A McCredie Journal: Neurocrit Care Date: 2020-06 Impact factor: 3.210