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Moderate Hypoglycemia is associated with vasospasm, cerebral infarction, and 3-month disability after subarachnoid hemorrhage.

Moderate Hypoglycemia is associated with vasospasm, cerebral infarction, and 3-month disability after subarachnoid hemorrhage.

Authors :
Naidech AM
Levasseur K
Liebling S
Garg RK
Shapiro M
Ault ML
Afifi S
Batjer HH
Naidech, Andrew M
Levasseur, Kimberly
Liebling, Storm
Garg, Rajeev K
Shapiro, Michael
Ault, Michael L
Afifi, Sherif
Batjer, H Hunt
Source :
Neurocritical Care. Apr2010, Vol. 12 Issue 2, p181-187. 7p.
Publication Year :
2010

Abstract

<bold>Background: </bold>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).<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
15416933
Volume :
12
Issue :
2
Database :
Academic Search Index
Journal :
Neurocritical Care
Publication Type :
Academic Journal
Accession number :
105151464
Full Text :
https://doi.org/10.1007/s12028-009-9311-z