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

Neurocrit Care. 2010 Apr;12(2):181-7. doi: 10.1007/s12028-009-9311-z.

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.

MeSH terms

  • Cerebral Infarction / diagnosis
  • Cerebral Infarction / diagnostic imaging
  • Cerebral Infarction / epidemiology*
  • Cerebral Infarction / physiopathology
  • Cerebral Infarction / rehabilitation
  • Disability Evaluation*
  • Female
  • Hospitalization
  • Humans
  • Hypoglycemia / blood
  • Hypoglycemia / epidemiology*
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Retrospective Studies
  • Subarachnoid Hemorrhage / diagnosis
  • Subarachnoid Hemorrhage / epidemiology*
  • Subarachnoid Hemorrhage / physiopathology
  • Time Factors
  • Tomography, X-Ray Computed
  • Vasospasm, Intracranial / diagnosis
  • Vasospasm, Intracranial / epidemiology*
  • Vasospasm, Intracranial / physiopathology