Inpatient hyperglycemia following aneurysmal subarachnoid hemorrhage: relation to cerebral metabolism and outcome

Neurocrit Care. 2009;11(1):56-63. doi: 10.1007/s12028-009-9222-z. Epub 2009 May 6.


Introduction: Despite its clear association with impaired prognosis, it remains controversial whether hyperglycemia after aneurysmal subarachnoid hemorrhage (SAH) actively contributes to neuronal damage. This study aimed to identify a threshold for blood glucose predicting unfavorable outcome, and to evaluate differences in cerebral metabolism in normo and hyperglycemic SAH patients.

Methods: Prospectively, blood glucose and cerebral metabolism, measured by cerebral microdialysis, were evaluated in 178 patients (WFNS grade I-V; age 51.6 +/- 12.4 years) during days 1-7 after SAH. Patients were classified into groups with mean blood glucose levels <or=/> 6.1 mmol/l (110 mg/dl) and 7.8 mmol/l (140 mg/dl). Glasgow Outcome Score was assessed after 12 months.

Results: Higher inpatient blood glucose was associated with impaired prognosis, with a threshold of 7.5 mmol/l (135 mg/dl) distinguishing best between favorable and unfavorable outcome. Inpatient glucose levels >6.1 mmol/l (110 mg/dl) were associated with higher cerebral lactate and lactate/pyruvate ratio (P < 0.05). Cerebral glucose was elevated only at blood levels >7.8 mmol/l (140 mg/dl). Inpatient glucose levels above 7.8 mmol/l (140 mg/dl) were independent predictors of unfavorable outcome and mortality.

Conclusion: Blood glucose levels >7.8 mmol/l (140 mg/dl), but not levels >6.1 mmol/l (110 mg/dl), independently predicted unfavorable outcome. While blood glucose levels >6.1 mmol/l (110 mg/dl) were already associated with slight metabolic derangements, cerebral glucose increased only at blood levels >7.8 mmol/l (140 mg/dl). Considering the risks associated with tight glycemic control, a moderate regimen accepting blood glucose levels up to 7.8 mmol/l (140 mg/dl) might be more reasonable after SAH.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Blood Glucose / metabolism
  • Brain / metabolism
  • Critical Care / methods*
  • Female
  • Glasgow Coma Scale
  • Humans
  • Hyperglycemia / diagnosis*
  • Hyperglycemia / metabolism*
  • Hyperglycemia / mortality
  • Inpatients
  • Male
  • Microdialysis / methods*
  • Middle Aged
  • Multivariate Analysis
  • Point-of-Care Systems
  • Predictive Value of Tests
  • Prospective Studies
  • Regression Analysis
  • Sensitivity and Specificity
  • Subarachnoid Hemorrhage / metabolism*
  • Subarachnoid Hemorrhage / mortality
  • Treatment Outcome


  • Blood Glucose