PURPOSE: High glucose variability is a significant marker for poor outcome in critically ill patients. We evaluated the impact of high glucose variability on cerebral infarction following spontaneous subarachnoid hemorrhage (SAH). MATERIALS AND METHODS: Consecutive adult patients with spontaneous SAH and Hunt Hess score of at least 3 were retrospectively identified. Patients were excluded if their intensive care unit length of stay was less than 24 hours or if there were less than 5 glucose assessments. Glucose values from the first 7 days of intensive care unit admission were assessed. Variability was calculated as the average change in glucose over time for each patient. Classification and regression tree analysis was used to determine high vs low glucose variability, and the incidence of cerebral infarction was compared. Multivariate analysis was used to control for confounding variables. RESULTS: There were 42 patients. Classification and regression tree analysis revealed a change in glucose greater than 9.52 mg/dL/h as the determinant for high variability. The incidence of cerebral infarction was 64% when glucose variability was high vs 20% when it was low (P=.006). Multivariate analysis identified high glucose variability (odds ratio [95% confidence interval]=11.4 [1.9-70.2], P=.008) and female sex (odds ratio [95% confidence interval]=5.2 [1-26.8], P=.047) as independent predictors for cerebral infarction. CONCLUSION: Glucose variability is a significant predictor of cerebral infarction in patients with severe spontaneous SAH.
PURPOSE: High glucose variability is a significant marker for poor outcome in critically illpatients. We evaluated the impact of high glucose variability on cerebral infarction following spontaneous subarachnoid hemorrhage (SAH). MATERIALS AND METHODS: Consecutive adult patients with spontaneous SAH and Hunt Hess score of at least 3 were retrospectively identified. Patients were excluded if their intensive care unit length of stay was less than 24 hours or if there were less than 5 glucose assessments. Glucose values from the first 7 days of intensive care unit admission were assessed. Variability was calculated as the average change in glucose over time for each patient. Classification and regression tree analysis was used to determine high vs low glucose variability, and the incidence of cerebral infarction was compared. Multivariate analysis was used to control for confounding variables. RESULTS: There were 42 patients. Classification and regression tree analysis revealed a change in glucose greater than 9.52 mg/dL/h as the determinant for high variability. The incidence of cerebral infarction was 64% when glucose variability was high vs 20% when it was low (P=.006). Multivariate analysis identified high glucose variability (odds ratio [95% confidence interval]=11.4 [1.9-70.2], P=.008) and female sex (odds ratio [95% confidence interval]=5.2 [1-26.8], P=.047) as independent predictors for cerebral infarction. CONCLUSION:Glucose variability is a significant predictor of cerebral infarction in patients with severe spontaneous SAH.
Authors: Pedro Kurtz; Jan Claassen; Raimund Helbok; J Schmidt; Luis Fernandez; Mary Presciutti; R Morgan Stuart; E Sander Connolly; Kiwon Lee; Neeraj Badjatia; Stephan A Mayer Journal: Crit Care Date: 2014-05-04 Impact factor: 9.097