Abstract
Background
Many ICUs have implemented protocols for tight glucose control, but there are few data on hypoglycemia and neurologic outcomes in patients with subarachnoid hemorrhage (SAH).
Methods
We prospectively ascertained 172 patients with SAH, who were treated according to a standard protocol for target glucose 80–110 mg/dl. Outcomes were assessed with the modified Rankin scale (mRS) at 14 days, 28 days, and 3 months.
Results
Worse neurologic injury at admission (P < 0.001) and a history of diabetes (P = 0.002) were associated with increased glucose variance. There was lower nadir glucose in patients with radiographic cerebral infarction (81 ± 15 vs. 87 ± 16 mg/dl, P = 0.02), symptomatic vasospasm (78 ± 12 vs. 84 ± 16 mg/dl, P = 0.04) and angiographic vasospasm (79 ± 14 vs. 86 ± 16 mg/dl, P = 0.01), but maximum and mean glucose values were not different. Glucose < 80 mg/dl was earlier and more frequent in patients with worse functional outcome at 3 months (P < 0.001). Progressive reductions in nadir glucose were associated with increasing functional disability at 3 months (P = 0.001) after accounting for neurologic grade and mean glucose. Severe hypoglycemia (<40 mg/dl) occurred in one patient.
Conclusions
In patients with SAH, nadir glucose < 80 mg/dl is associated with cerebral infarction, vasospasm, and worse functional outcomes in multivariate models. Protocols for target glucose 80–110 mg/dl effectively control hyperglycemia, but may place patients with SAH at risk for vasospasm, cerebral infarction, and poor outcome even when severe hypoglycemia does not occur.
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Acknowledgments
This work was departmentally funded. The authors acknowledge the team at the Enterprise Data Warehouse who built the portal for electronic retrieval of laboratory and medication data. The Enterprise Data Warehouse is a joint project of Northwestern Memorial Hospital, Northwestern University, and the Northwestern Memorial Faculty Foundation. More information is available at www.edw.northwestern.edu.
Conflict of Interest Statement
AMN has received past grant support from the Neurocritical Care Society, NovoNordisk, and the Northwestern Memorial Foundation, and current grant support from Gaymar Inc and Astellas Pharma US for unrelated work. AMN has received past speaker fees from EKR Therapeutics (ended 2008). It is unclear how these might relate to this manuscript.
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Naidech, A.M., Levasseur, K., Liebling, S. et al. Moderate Hypoglycemia is Associated With Vasospasm, Cerebral Infarction, and 3-Month Disability After Subarachnoid Hemorrhage. Neurocrit Care 12, 181–187 (2010). https://doi.org/10.1007/s12028-009-9311-z
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DOI: https://doi.org/10.1007/s12028-009-9311-z