| Systemic glucose and brain energy metabolism after subarachnoid hemorrhage. | |
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MedLine Citation:
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PMID: 20135362 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Brain energy metabolic crisis (MC) and lactate-pyruvate ratio (LPR) elevations have been linked to poor outcome in comatose patients. We sought to determine if MC and LPR elevations after subarachnoid hemorrhage (SAH) are associated with acute reductions in serum glucose. METHODS: Twenty-eight consecutive comatose SAH patients that underwent multimodality monitoring with intracranial pressure and microdialysis were studied. MC was defined as lactate/pyruvate ratio (LPR) > or = 40 and brain glucose < 0.7 mmol/l. Time-series data were analyzed using a multivariable general linear model with a logistic link function for dichotomized outcomes. RESULTS: Multimodality monitoring included 3,178 h of observation (mean 114 +/- 65 h per patient). In exploratory analysis, serum glucose significantly decreased from 8.2 +/- 1.8 mmol/l (148 mg/dl) 2 h before to 6.9 +/- 1.9 mmol/l (124 mg/dl) at the onset of MC (P < 0.001). Reductions in serum glucose of 25% or more were significantly associated with new onset MC (adjusted odds ratio [OR] 3.6, 95% confidence interval [CI] 2.2-6.0). Acute reductions in serum glucose of 25% or more were also significantly associated with an LPR rise of 25% or more (adjusted OR 1.6, 95% CI 1.1-2.4). All analyses were adjusted for significant covariates including Glasgow Coma Scale and cerebral perfusion pressure. CONCLUSIONS: Acute reductions in serum glucose, even to levels within the normal range, may be associated with brain energy metabolic crisis and LPR elevation in poor-grade SAH patients. |
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Authors:
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Raimund Helbok; J Michael Schmidt; Pedro Kurtz; Khalid A Hanafy; Luis Fernandez; R Morgan Stuart; Mary Presciutti; Noeleen D Ostapkovich; E Sander Connolly; Kiwon Lee; Neeraj Badjatia; Stephan A Mayer; Jan Claassen |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Neurocritical care Volume: 12 ISSN: 1556-0961 ISO Abbreviation: Neurocrit Care Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-05-03 Completed Date: 2010-08-03 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101156086 Medline TA: Neurocrit Care Country: United States |
Other Details:
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Languages: eng Pagination: 317-23 Citation Subset: IM |
Affiliation:
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Division of Critical Care Neurology, Department of Neurology, Columbia University Medical Center, Milstein Hospital 8 Center, 177 Fort Washington Ave, New York, NY 10032, USA. raimund.helbok@uki.at |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Blood Glucose / metabolism* Blood Pressure / physiology Brain / physiopathology* Critical Care / methods Energy Metabolism / physiology* Equipment Design Female Glasgow Coma Scale Hospital Mortality Humans Hypoglycemia / physiopathology Intracranial Pressure / physiology Lactic Acid / blood* Male Microdialysis Middle Aged Monitoring, Physiologic / instrumentation* Oxygen Consumption / physiology Prognosis Pyruvic Acid / blood* Signal Processing, Computer-Assisted / instrumentation* Subarachnoid Hemorrhage / mortality, physiopathology* Subarachnoid Hemorrhage, Traumatic / mortality, physiopathology* |
| Chemical | |
Reg. No./Substance:
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0/Blood Glucose; 127-17-3/Pyruvic Acid; 50-21-5/Lactic Acid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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