Document Detail


Effective glycemic control with aggressive hyperglycemia management is associated with improved outcome in aneurysmal subarachnoid hemorrhage.
MedLine Citation:
PMID:  19286596     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Hyperglycemia strongly predicts poor outcome in patients with aneurysmal subarachnoid hemorrhage, but the effect of hyperglycemia management on outcome is unclear. We studied the impact of glycemic control on outcome of patients with aneurysmal subarachnoid hemorrhage.
METHODS: A prospective intensive care unit database was used to identify 332 patients with hyperglycemic aneurysmal subarachnoid hemorrhage admitted between January 2000 and December 2006. Patients treated with an aggressive hyperglycemia management (AHM) protocol after 2003 (N=166) were compared with 166 patients treated using a standard hyperglycemia management before 2003. Within the AHM group, outcome was compared between patients who achieved good (mean glucose burden <1.1 mmol/L) and poor (mean glucose burden >or=1.1 mmol/L) glycemic control. Poor outcome was defined as modified Rankin scale >or=4 at 3 to 6 months. Multivariable logistic regression models correcting for temporal trend were used to quantify the effect of AHM on poor outcome.
RESULTS: Poor outcome in AHM-treated patients was lower (28.31% versus 40.36%) but was not statistically significant after correcting for temporal trend. However, good glycemic control significantly reduced the incidence of poor outcome (OR, 0.25; 95% CI, 0.08 to 0.80; P=0.02) compared with patients with poor glycemic control within the AHM group. No difference in the rate of clinical vasospasm or the development of delayed ischemic neurological deficit was seen before and after AHM protocol implementation.
CONCLUSIONS: AHM results in good glucose control and significantly reduces the odds for poor outcome after aneurysmal subarachnoid hemorrhage in glucose-controlled patients. Further studies are needed to confirm these results.
Authors:
Julius Gene S Latorre; Sherry Hsiang-Yi Chou; Raul Gomes Nogueira; Aneesh B Singhal; Bob S Carter; Christopher S Ogilvy; Guy A Rordorf
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2009-03-12
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  40     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-28     Completed Date:  2009-05-14     Revised Date:  2011-02-16    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1644-52     Citation Subset:  IM    
Affiliation:
Department of Neurology, SUNY Upstate Medical University, Syracuse, NY 13210, USA. latorrej@upstate.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Glucose / metabolism*
Data Interpretation, Statistical
Databases, Factual
Female
Humans
Hyperglycemia / blood*,  prevention & control*
Hypoglycemic Agents / therapeutic use*
Insulin / therapeutic use*
Logistic Models
Male
Middle Aged
Odds Ratio
Prospective Studies
Subarachnoid Hemorrhage / blood*,  therapy*
Treatment Outcome
Grant Support
ID/Acronym/Agency:
K30 RR022292-07/RR/NCRR NIH HHS; K30-RR022292-07/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Blood Glucose; 0/Hypoglycemic Agents; 11061-68-0/Insulin
Comments/Corrections

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