Value of Glycemic Indices for Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: A Retrospective Single-Center Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Patient Selection
2.2. Data Collection
2.3. Standard Treatment Algorithm
2.4. Determination of the Times for aSAH Event and DCI Onset
2.5. Analysis of Blood Glucose Values
2.6. Statistics
3. Results
3.1. Study Population
3.2. Increased Blood Glucose Values before DCI Onset
3.3. No Difference in Blood Glucose Fluctuation before DCI Onset
3.4. Higher Time-Unified Dysglycemic Rate before DCI Onset
3.5. Time-Weighted Average Glucose Associated Positively with DCI
3.6. Time-Weighted Average Glucose and Time-Unified Dysglycemic Rate as Marker for DCI Onset
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AACTD | Average absolute change by time difference |
aSAH | Aneurysmal subarachnoid hemorrhage |
CV | Coefficient of glycemic variation |
CT | Computed tomography scan |
DCI | Delayed cerebral ischemia |
ICD | International Classification of Diseases |
ICH | Intracranial hemorrhage |
ICU | Intensive care unit |
MBG | Mean blood glucose |
mFisher score | Modified Fisher score |
SAH | Subarachnoid hemorrhage |
SDH | Subdural hematoma |
SAPS II | Simplified acute physiology score |
TUDR | Time-unified dysglycemic rate |
TUDR140 | Time-unified dysglycemic rate with target blood glucose range: 70–140 mg/dL |
TUDR160 | Time-unified dysglycemic rate with target blood glucose range: 70–160 mg/dL |
TUDR180 | Time-unified dysglycemic rate with target blood glucose range: 70–180 mg/dL |
TWAG | Time-weighted average glucose |
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Study Population | Delayed Cerebral Ischemia | |||
---|---|---|---|---|
Variable | Total (n = 151) | No (n = 81) | Yes (n = 70) | p-Value |
Demography | ||||
Age [years] | 55.2 ± 12.4 | 57.2 ± 12.6 | 52.9 ± 11.8 | 0.035 |
Sex (female) | 101 (66.9%) | 53 (65.4%) | 48 (68.6%) | 0.731 |
Body mass index [kg/m2] a | 26.3 ± 5.5 | 26.0 ± 4.9 | 26.5 ± 6.1 | 0.691 |
Medical history | ||||
Diabetes mellitus type 2 | 7 (4.6%) | 6 (7.4%) | 1 (1.4%) | 0.123 |
Hypertension | 66 (43.7%) | 39 (48.1%) | 27 (38.6%) | 0.254 |
Stroke history | 7 (4.6%) | 3 (3.7%) | 4 (5.7%) | 0.705 |
History of SAH | 6 (4.0%) | 3 (3.7%) | 3 (4.3%) | 1.000 |
Chronic kidney failure | 1 (0.7%) | 1 (1.2%) | 0 (0.0%) | 1.000 |
Chronic liver disease | 3 (2.0%) | 2 (2.5%) | 1 (1.4%) | 1.000 |
Psychiatric disorder | 14 (9.3%) | 9 (11.1%) | 5 (7.1%) | 0.575 |
Alcohol addiction | 13 (8.6%) | 6 (7.4%) | 7 (10.0%) | 0.578 |
Smoking history | 51 (33.8%) | 26 (32.1%) | 25 (35.7%) | 0.731 |
Sah scores | ||||
Hunt and Hess score | ||||
1–3 | 105 (69.5%) | 60 (74.1%) | 45 (64.3%) | 0.293 |
4–5 | 46 (30.4%) | 21 (25.9%) | 25 (35.7%) | 0.217 |
mFisher score | ||||
1–2 | 72 (47.7%) | 51 (63.0%) | 21 (30.0%) | <0.001 |
3–4 | 79 (52.3%) | 30 (37.0%) | 49 (70.0%) | <0.001 |
Sah treatment | ||||
Endovascular treatment b | 90 (59.6%) | 49 (60.4%) | 41 (58.6%) | 1.000 |
Surgical clipping b | 57 (37.7%) | 29 (35.8%) | 28 (40.0%) | 0.617 |
Time from onset to ICU admission [h] | 10.1 ± 12.7 | 10.2 ± 13.9 | 9.9 ± 11.2 | 0.902 |
Ruptured aneurysm location | ||||
Internal carotid | 18 (11.9%) | 7 (8.6%) | 11 (15.7%) | 0.213 |
Anterior cerebral | 15 (9.9%) | 8 (9.9%) | 7 (10.0%) | 1.000 |
Anterior communicating | 52 (34.4%) | 26 (32.1%) | 26 (37.1%) | 0.607 |
Middle cerebral | 34 (22.5%) | 19 (23.5%) | 15 (21.4%) | 0.846 |
Posterior communicating | 15 (9.9%) | 9 (11.1%) | 6 (8.6%) | 0.786 |
Vertebral | 6 (4.0%) | 4 (4.9%) | 2 (2.9%) | 0.686 |
Basilar | 10 (6.6%) | 7 (8.6%) | 3 (4.3%) | 0.341 |
Other | 1 (0.7%) | 1 (1.2%) | 0 (0.0%) | 1.000 |
ICU key facts | ||||
SAPS II Score a | 37.4 ± 9.1 | 36.0 ± 9.0 | 39.1 ± 9.2 | 0.039 |
ICU length of stay [d] | 25.2 ± 15.0 | 19.6 ± 10.8 | 31.7 ± 16.5 | <0.001 |
ICU mortality | 28 (18.5%) | 9 (11.1%) | 19 (27.1%) | 0.020 |
Hospital length of stay [d] | 30.2 ± 16.2 | 25.2 ± 12.1 | 36.1 ± 18.3 | <0.001 |
Mechanical ventilation [h] | 366.4 ± 417.5 | 235.8 ± 328.0 | 517.6 ± 459.3 | <0.001 |
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Deininger, M.M.; Weiss, M.; Wied, S.; Schlycht, A.; Haehn, N.; Marx, G.; Hoellig, A.; Schubert, G.A.; Breuer, T. Value of Glycemic Indices for Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: A Retrospective Single-Center Study. Brain Sci. 2024, 14, 849. https://doi.org/10.3390/brainsci14090849
Deininger MM, Weiss M, Wied S, Schlycht A, Haehn N, Marx G, Hoellig A, Schubert GA, Breuer T. Value of Glycemic Indices for Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: A Retrospective Single-Center Study. Brain Sciences. 2024; 14(9):849. https://doi.org/10.3390/brainsci14090849
Chicago/Turabian StyleDeininger, Matthias Manfred, Miriam Weiss, Stephanie Wied, Alexandra Schlycht, Nico Haehn, Gernot Marx, Anke Hoellig, Gerrit Alexander Schubert, and Thomas Breuer. 2024. "Value of Glycemic Indices for Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: A Retrospective Single-Center Study" Brain Sciences 14, no. 9: 849. https://doi.org/10.3390/brainsci14090849